仙骨腹仙骨式摘出術を施行した骨盤内孤立性線維性腫瘍の1例

Surgical resection of solitary fibrous tumor arising from the pelvis by sacroabdominosacral route approach

◆要旨：患者は52歳，男性．胆囊結石に対する腹腔鏡下胆囊摘出術の既往があった．腹部症状は認めないが血尿の精査で施行された腹部CT検査で偶然に骨盤内腫瘍が発見され，諸検査後に摘出手術を施行した．経仙骨的と経腹的の二方向からアプローチして下部直腸とともに腫瘍を摘出したが，経腹的操作は腹腔鏡下に遂行した．腹腔鏡下に腫瘍の全貌を認識することは困難であったが，骨盤内操作は良視野で遂行可能であった．また，煩雑であったものの二方向からのアプローチは腫瘍を一塊として摘出するために有用であった．摘出腫瘍は孤立性線維性腫瘍と最終診断したが，腫瘍と直腸との連続性は認められず，直腸間膜内に発生したものと考えられた．

　The patient was a 52-year-old male with a past history of laparoscopic cholecystectomy for cholecystolithiasis. He complained of hematuria and abdominal CT was performed for further examination. The CT showed a round mass in the pelvic cavity. Operation was performed by both trans-abdominal and trans-sacral route approach. The trans-abdominal approach was performed under laparoscopic method. Although we could not grasp the full view of the tumor, we were able to abrade around the rectum with a comparatively good view under laparoscope. We removed the tumor with lower rectum as a mass. The two route approach was complicated but was effective for the excision of the tumor as a mass. Histological examination showed the tumor to be solitary fibrous tumor arising from the mesenterium of the rectum.