腹腔鏡補助下結腸・脾切除術を施行した脾機能亢進症を合併した横行結腸早期癌の1例

A Case of Early Transverse Colon Cancer and Hypersplenism Successfully Managed by Laparoscopy-assisted Colectomy and Splenectomy

　症例は67歳女性で，右結腸曲近傍の横行結腸に内視鏡的治療が困難な早期大腸癌を認めた．肝硬変による脾機能亢進症に伴う血小板数減少，出血傾向があり，治療法の選択に苦慮した．腹腔鏡下脾臓摘出術を先行し，一期的に腹腔鏡補助下結腸切除術を施行した．術後，血小板数は正常化し，出血傾向も消失した．肝硬変による脾機能亢進症に伴う血小板数減少，出血傾向に対する腹腔鏡下脾臓摘出術の適応には議論の余地は残るが，腹腔鏡下脾臓摘出術の手技と安全性が確立された現在，他の腹腔鏡下手術と脾臓摘出術の併施は有用な術式であることが示唆された．

We report case of early transverse colon cancer with thrombocytopenia due to liver cirrhosis and hypersplenism that was successfully treated by laparoscopic colectomy and splenectomy. A 67-year-old woman with a laterally spreading tumor of the transverse colon was admitted to Tochigi Cancer Center. Endoscopic resection of the tumor was cosidered difficult because of the technically difficult location and the shape of the tumor, as well as the bleeding tendency due to thrombocytopenia. Hypersplenism was causing thrombocytopenia, and it was necessary to treat this prior to the resection of colonic tumor.