腹腔鏡下に切除しえた後腹膜原発paragangliomaの1例

Laparoscopic resection of a retroperitoneal paraganglioma : a case report

◆要旨：患者は50歳，女性．腹痛を主訴に近医を受診した．腹部腫瘤を指摘され，精査加療目的に当院へ紹介となった．精査の結果，大動脈，下大静脈，左腎静脈に囲まれた類円形の腫瘤を認め，非機能性paragangliomaを疑い，腹腔鏡下手術の方針となった．大血管周囲の腹腔鏡操作は危険を伴うため，このような症例への腹腔鏡下手術の報告は少ない．しかし，大血管をテーピングしできるだけ間接的に牽引すること，拡大視効果により剝離すべき層をしっかりと認識できることなどから，安全かつ低侵襲に手術施行可能であった．

　A 50-year-old woman visited her regular doctor with the chief complaint of abdominal pain. Imaging modalities revealed an approximately 3-cm abdominal mass close to the aorta, inferior vena cava, and left renal vein. With a presumptive diagnosis of non-functional paraganglioma, laparoscopic resection was performed. The postoperative course was uneventful, and the patient was discharged on the third postoperative day. The histopathological diagnosis was retroperitoneal paraganglioma. The surgical margins were histologically clear. Laparoscopic resection of tumor adherent to the major vessels has high risks, therefore this procedure has remained a formidable challenge for many surgeons. However, by tapering the major vessels, a good and magnified view of the surgical field was obtained and the procedure was successfully performed by meticulous manipulation, Laparoscopic resection is minimally invasive, safe and feasible in selected patients with retroperitoneal paraganglioma.