内容紹介
A Case of Laparoscopy Assisted Ileocecal Resection for Large Appendiceal Mucinous Adenocarcinoma
Summary
Appendiceal mucinous adenocarcinoma accompanied by cysts ruptures by surgical operation and leakage of mucus into the peritoneal cavity results in deterioration of prognosis. We report a case where the appendix mucinous adenocarcinoma was safely excised by laparoscopically preceding vascular treatment, lymph node dissection and intestinal dissection. The case was a woman in her forty-age suffering from the right lower quadrant and fever; no improvement was observed even when antibiotics were administered. A cystic lesion with a maximum diameter of 75 mm was found on the right side of the pelvis with CT, and numerous lymph adenopathy was observed along the iliac artery. Preoperative diagnosis was diagnosed as appendiceal mucinous adenocarcinoma suspected and laparoscopic resection of the cecum was performed with the above procedure without breaking the cyst. Pathological diagnosis was findings of appendicular mucinous adenocarcinoma. She was discharged on the 7th postoperative day after surgery, 6 months after surgery without relapse survival. In order to resect a cystic tumor by laparoscopic surgery, it is considered to be useful to take care to prevent the forceps from touching the tumor, and perform a procedure that precedes vascular dissection and intestinal dissection.
要旨
囊腫を伴う虫垂粘液腺癌は手術操作で破裂し,粘液が腹腔内に漏出すると予後の悪化をもたらす。虫垂粘液腺癌に対し,腹腔鏡下に血管処理,リンパ節郭清,腸管の切離を先行させ安全に摘出した症例を経験したので報告する。症例は40代,女性。主訴は右下腹部と発熱であり,抗菌薬投与するも改善を認めなかった。CTにて骨盤右側に最大径75 mmの囊胞性病変を認め,回結腸動脈に沿って多数のリンパ節腫大を認めた。術前診断は虫垂粘液腺癌の疑いと診断し,腹腔鏡下回盲部切除術を囊腫を破ることなく上記の手順で施行した。病理診断は虫垂粘液腺癌の所見であった。術後経過良好で術後7日目に退院し,術後6か月無再発生存中である。囊胞性腫瘍を腹腔鏡手術で切除するには,腫瘍に鉗子が触れないように配慮し,血管切離と腸管切離を先行して行う術式が有用と考える。
目次
Summary
Appendiceal mucinous adenocarcinoma accompanied by cysts ruptures by surgical operation and leakage of mucus into the peritoneal cavity results in deterioration of prognosis. We report a case where the appendix mucinous adenocarcinoma was safely excised by laparoscopically preceding vascular treatment, lymph node dissection and intestinal dissection. The case was a woman in her forty-age suffering from the right lower quadrant and fever; no improvement was observed even when antibiotics were administered. A cystic lesion with a maximum diameter of 75 mm was found on the right side of the pelvis with CT, and numerous lymph adenopathy was observed along the iliac artery. Preoperative diagnosis was diagnosed as appendiceal mucinous adenocarcinoma suspected and laparoscopic resection of the cecum was performed with the above procedure without breaking the cyst. Pathological diagnosis was findings of appendicular mucinous adenocarcinoma. She was discharged on the 7th postoperative day after surgery, 6 months after surgery without relapse survival. In order to resect a cystic tumor by laparoscopic surgery, it is considered to be useful to take care to prevent the forceps from touching the tumor, and perform a procedure that precedes vascular dissection and intestinal dissection.
要旨
囊腫を伴う虫垂粘液腺癌は手術操作で破裂し,粘液が腹腔内に漏出すると予後の悪化をもたらす。虫垂粘液腺癌に対し,腹腔鏡下に血管処理,リンパ節郭清,腸管の切離を先行させ安全に摘出した症例を経験したので報告する。症例は40代,女性。主訴は右下腹部と発熱であり,抗菌薬投与するも改善を認めなかった。CTにて骨盤右側に最大径75 mmの囊胞性病変を認め,回結腸動脈に沿って多数のリンパ節腫大を認めた。術前診断は虫垂粘液腺癌の疑いと診断し,腹腔鏡下回盲部切除術を囊腫を破ることなく上記の手順で施行した。病理診断は虫垂粘液腺癌の所見であった。術後経過良好で術後7日目に退院し,術後6か月無再発生存中である。囊胞性腫瘍を腹腔鏡手術で切除するには,腫瘍に鉗子が触れないように配慮し,血管切離と腸管切離を先行して行う術式が有用と考える。