術中囊胞内容液を穿刺吸引し腹腔鏡下に切除した脾リンパ管奇形の1例

A case of huge lymphatic malformation derived from spleen resected successfully under laparoscopic surgery by puncture and suction of the content fluid

◆要旨：患者は31歳，女性．上腹部痛と食欲不振を主訴に近医を受診し，脾腫瘍と診断され当科へ紹介された．CT上，脾臓に径12cm大の多房性囊胞性腫瘤を認めた．脾リンパ管奇形と診断し，腹腔鏡下脾臓摘出術を行った．腫瘤は多房性ではあったが大きな囊胞成分を含んでいたので，術中，囊胞を穿刺し内容液を吸引し腫瘤を縮小させた．これにより，脾門の脈管処理を安全に行うことができた．径の大きい囊胞性腫瘤であったが，囊胞内容液を吸引することによって腹腔鏡下で手術を完遂することができた．病理学的診断は脾原発リンパ管奇形であった．

　A 31-year-old woman with upper abdominal pain and anorexia visited a local clinic, wherein a huge cystic lesion in the upper abdomen was detected on ultrasonography, after which, she visited our hospital. Computed tomography revealed a 12cm multilocular cystic lesion in the spleen. Magnetic resonance imaging showed that the lesion had low signal on T1 weighted image and high signal on T2 weighted image and that there was no solid lesion. Using these examinations, we diagnosed this cystic lesion as lymphatic malformation derived from the spleen, and we performed laparoscopic splenectomy. The huge cystic lesion of the spleen completely occupied the upper abdominal space, so we punctured the lesion and sucked out the content fluid. Thereafter we could shrink this cystic lesion and perform laparoscopic splenectomy safely. The histological finding of the resected specimen was lymphatic malformation derived from the spleen.