腹腔鏡補助下腹会陰式直腸切断術を施行した直腸原発悪性黒色腫の1例

Laparoscopy-assisted abdominoperineal resection of the rectum for anorectal malignant melanoma

患者は67歳，女性．2005年1月に排便時出血を認め，前医で大腸内視鏡を施行した．下部直腸に黒色調の腫瘤性病変を認め，当院に紹介となった．精査の結果，直腸悪性黒色腫の診断で手術を施行した．腹腔鏡下に中枢側D2郭清を施行し，自律神経を温存した．次いで会陰操作を行い，直腸切断術を終了した．病理組織学的検査の結果はmp，ly1，v1，n（－），stageI，根治度Aであった．術後化学療法を継続し，1年経過した現在再発はなく生存中である．本疾患は予後が極めて不良であり，患者のQOLを重視した本術式も今後治療法選択の1つとして考慮されるべきであると思われた．

　We report a case of a patient who underwent laparoscopy-assisted abdominoperineal resection of the rectum for the treatment of anorectal malignant melanoma. A 67-year-old woman presented at another institution complaining of anal bleeding. On rectal endoscopy, a blackish mass was found, so the patient was admitted to our hospital for detailed examinations. A biopsy specimen was histologically and immunohistologically diagnosed as being anorectal malignant melanoma ; therefore, the patient underwent laparoscopy-assisted abdominoperineal resection of the rectum. Histologically, the tumor was classified as mp, ly 1, v 1, n （-）, stage I, and CurA. After surgery, the patient received adjuvant chemotherapy, and at the time of writing she had survived for 1 year after the operation without any sign of recurrence. The prognosis of anorectal malignant melanoma is generally very poor. The surgical approach described here has benefits with respect to the patient's quality of life, and therefore should be considered when deciding on therapy.