超高齢者に発生した舌根部腺様囊胞癌の1例

Adenoid cystic carcinoma of the base of the tongue in the oldest age

Ⅰ　はじめに

　現在，わが国が高齢化社会を迎えているのに伴って，医療者側は，かつて経験しなかったような高齢患者の治療に直面している。高齢者は一般的に，手術侵襲に対する耐性が低く，術後合併症のリスクも高いため，治療方針の決定や手術法の選択に際しては，細心の注意が必要である^1）。

　老年医学では，高齢者の定義は65歳以上，その中で75歳以上を後期高齢者，85歳以上または90歳以上から超高齢者とするというのが一般的である^2）。今回われわれは，超高齢者で直腸癌の手術中に偶然発見された舌根部腺様囊胞癌症例を治療する機会を得たので，舌根部由来の良・悪性腫瘍の分類，手術アプローチ，ならびに超高齢者に対する手術選択について文献的考察を加え報告する。

　A 91-year-old woman with adenoid cystic carcinoma of the base of the tongue was reported. She presented with a large painless mass in the throat,and computed tomography revealed a well-defined lobulated tumor measuring 48 mm in diameter arising from the base of the tongue. The tumor was successfully resected via transoral approach using an ultrasonic scalpel. Because the tumor invasion of the surrounding tissue was limited,the surgical defect was relatively small and no reconstructive procedure was performed. The tumor was histopathologically diagnosed as adenoid cystic carcinoma of the minor salivary gland. Her postoperative clinical course was uneventful. No aspiration or difficulty upon deglutition was recognized when she started transoral ingestion on the fourth postoperative day. The patient was currently free from disease 14 months after surgery.