腹腔鏡下に摘出した特発性巨大chronic expanding hematomaの1切除例

A case of laparoscopic resection of giant retroperitoneal hematoma

◆要旨：患者は50歳，女性．201X年1月当院内科で高血圧の精査を目的に施行した腹部造影CT検査で一部造影効果を伴う8cm大の後腹膜腫瘤を指摘され当科紹介となった．後腹膜血腫が疑われたが出血変性を伴う非機能性後腹膜腫瘍も否定できなかった．本腫瘤は下大静脈を腹側より圧排して下肢うっ血をきたしている可能性があることから腹腔鏡下後腹膜腫瘍摘出術を施行した．気腹によりBMI 30.54kg/m²であっても十分に視野を確保でき，小腸間膜根より後腹膜に到達し，腫瘍を慎重に剝離して摘出しえた．病理診断は線維増生により被包化された後腹膜血腫で，悪性所見はみられなかった．腹腔鏡による拡大視効果や水平方向からの視野により巨大腫瘍であっても摘出が可能であると思われた．

　A 50-year-old woman was referred to the Department of Internal Medicine of Hyogo Prefectural Nishinomiya Hospital in January 201X for close monitering of hypertension. Abdominal contrast computer tomography revealed a retroperitoneal mass, measuring 8cm in diameter, with an enhanced component. She was thus referred to our department for consultation to determine whether surgery was indicated. Although retroperitoneal hematoma was suspected preoperatively, non-functional retroperitoneal tumor with denatured bleeding could not be completely ruled out. It was found that this tumor was compressing the inferior vena cava from the ventral side. Therefore, laparoscopic retroperitoneal tumor resection was performed. Even though the patient's body mass index was 30.54kg/cm², we were able to perform laparoscopic resection safely. The tumor was carefully dissected through retroperitoneal approach via the mesenteric pedicle. Good visualization was possible with the use of pneumoperitoneum. Histologically, the tumor was a retroperitoneal hematoma with encapsulated fibrosis and was not malignant. Laparoscopic surgery allowed expansion as well as horizontal direction of the visual field, making it possible to resect this giant tumor.