細径鉗子を併用し腹腔鏡下に切除しえた腹腔神経叢由来神経鞘腫の1例

Laparoscopic surgery with concomitant use of needlescopic devices for schwannoma arising from nerve plexus around celiac trunk

◆要旨：患者は31歳の女性で，健診時の腹部超音波検査で腹部腫瘤を指摘され，精査目的で当院に紹介となった．腹部CTで腹腔動脈幹右側に46mm大の境界明瞭な腫瘤を認め，超音波内視鏡下穿刺吸引法（EUS-FNA）で神経鞘腫と診断された．手術は整容性にも配慮して細径鉗子を用い，腹腔鏡下腫瘍摘出術を施行した．腫瘍は腹腔動脈幹周囲の神経叢と連続性を認めたため，同神経叢由来の神経鞘腫と考えられた．極めて稀な腹腔神経叢由来神経鞘腫に対する腹腔鏡下手術は安全で有用と考えられた．

　A 31-year-old woman with abdominal distension and back pain was found to have abdominal tumor by ultrasound examination during medical checkup. Abdominal CT showed a well-defined tumor measuring 46mm in diameter adjacent to the right side of the celiac trunk. The tumor was diagnosed as schwannoma by endoscopic ultrasound fine needle aspiration. Laparoscopic resection of the tumor was performed with concomitant use of needlescopic devices in order to improve the esthetic outcome. The tumor was located directly adjacent to the nerve plexus around the celiac trunk, thus we concluded that the tumor had originated from this plexus. Here, we report this relatively rare case of schwannoma arising from nerve plexus around the celiac trunk with a review of the literature.