腹腔鏡補助下で切除しえたvon Recklinghausen病に合併した多発小腸GISTの1例

Laparoscopically assisted intestinal resection of the multiple GIST in a patient with von Recklinghausen disease

　患者は69歳の女性であり，生後より全身に白斑を認め，腹部に軟らかい結節が多発していた．4か月前よりめまい，貧血，下血を認め，当院を受診し入院となった．上部下部消化管内視鏡では出血源は同定できず，小腸造影を施行し小腸腫瘍が指摘された．また胆石症も指摘されたため，腹腔鏡下胆嚢摘出術および腹腔鏡補助下小腸切除術を施行した．術中に全小腸を検索し小腸腫瘍を計4か所に認めた．病理組織学的所見では小腸腫瘍はCD34とc-kitが陽性であり，多発小腸GISTと診断した．また，皮膚結節の生検でvon Recklinghausen病と診断された．今回von Recklinghausen病に合併した多発性小腸GIST（gastrointestinal stromal tumor）を腹腔鏡下で安全に手術を行えた症例を経験したので報告する．

The patient was a 69 years old woman with vitiligo throughout her body since birth. She frequently felt a soft knot appearing in the abdomen. She was hospitalized because of vertigo, anemia, and bloody bowel discharge which she had been experiencing for the past 4 months. The cause of bleeding could not be indentified by endoscopic examination. Radiological enteroclysis, however, revealed an intestinal tumor. Because there was cholecystolithiasis, we performed laparoscopic cholecystectomy and laparoscopically assisted small intestinal re-section. During the operation, intestinal tumors were found in 4 different sites.