腹腔鏡下手術を施行した腸間膜囊胞性リンパ管腫の1例

A case of mesenteric cystic lymphangioma managed by laparoscopic surgery

◆要旨：患者は65歳の女性．5年前に腹部腫瘤を自覚し当院内科を受診した．精査にて右上腹部に5cm大の単房性囊胞性腫瘤を認めたが無症状のため経過観察されていた．しかし増大傾向があり，当科紹介となった．腹部CT検査では7cmと増大していたが性状は囊胞性を維持していた．消化管の精査では異常を認めず，腹部血管造影検査では空腸動脈圧排像のみで腫瘍濃染像は認めなかった．腸間膜もしくは大網由来の囊胞性腫瘤と診断し腹腔鏡下摘出術を施行した．腫瘤は小腸間膜に存在し表面平滑で境界明瞭，病理組織学的に囊胞性リンパ管腫と診断された．腸間膜リンパ管腫は比較的稀な疾患であり，腹腔鏡下手術で診断かつ治療が行えた症例を経験したのでここに報告する．

　We reported a case of mesenteric cystic lymphangioma which was excised under laparoscopic surgery. A 65-year-old woman had been diagnosed with a nonsymptomatic cystic lesion 5 cm in diameter in the abdominal cavity for 5 years. On June 1997, she presented to our department with increasing size of the cystic lesion and fullness of abdomen. Abdominal CT showed that the tumor had increased in size but was still cystic. Upper gastrointestinal endscopy and colonoscopy showed no abnormal findings. Abdominal angiography revealed that the jejunal artery was compressed but there was no feeding artery for the cystic lesion. We performed laparoscopic surgery with a diagnosis of a cystic lesion originating from the mesenterium or omentum. The cystic lesion was located in the mesenterium of small intestine. Histopathological diagnosis of the resected specimen was mesenteric cystic lymphangioma, which is relatively rare.