内容紹介
Summary
Appendiceal mucinous neoplasm has a risk for pseudomyxoma peritonei caused by appendiceal perforation. It has been reported that laparoscopic surgery is more risky than open surgery. We investigated 4 patients who underwent laparoscopic surgery for appendiceal mucinous neoplasm. The median age was 69.5(49-85). There were 3 males and 1 female. Three cases of partial laparoscopic resection of the cecum and 1 case of ileocecal resection with lymph node dissection were performed. The pathology was low-grade mucinous neoplasm in all cases. The median hospital stay was 6 days, and there were no postoperative complications(CD Grade 3 or higher)or hospital death. As for long-term results, peritoneal pseudomyxoma developed in 1 case, which had already ruptured at the time of surgery. There were no recurrences in other cases. This result suggests that laparoscopic surgery for appendiceal mucinous neoplasm is safe with optimal selection of the procedure and a protective technique.
要旨
虫垂粘液産生腫瘍は良性腫瘍に分類されるが,穿破を契機に腹膜偽粘液腫を来すリスクがあり,腹腔鏡下手術の安全性は確立されていない。当科関連施設で虫垂粘液産生腫瘍に対して腹腔鏡下手術を行った4例を後ろ向きに調査した。年齢の中央値は69.5(49～85)歳,男性3例,女性1例であった。術式は盲腸部分切除3例,リンパ節郭清を伴う回盲部切除が1例。1例で腹腔内観察時,すでに穿破および周囲への腹膜偽粘液腫を認めたが,その他の症例において術中操作による穿破はなかった。病理診断は全例で低異型度虫垂粘液性腫瘍(low-grade mucinous neoplasm)であった。術後合併症(Clavien-Dindo分類Grade 3以上)は認めず,在院日数の中央値は6日であった。長期成績は,手術時すでに穿破していた1例を除き再発を認めなかった(観察期間中央値14.8か月)。虫垂粘液産生腫瘍に対する腹腔鏡下手術は,選択肢の一つになり得ると考えられる。さらなる症例集積が必要である。
目次
Appendiceal mucinous neoplasm has a risk for pseudomyxoma peritonei caused by appendiceal perforation. It has been reported that laparoscopic surgery is more risky than open surgery. We investigated 4 patients who underwent laparoscopic surgery for appendiceal mucinous neoplasm. The median age was 69.5(49-85). There were 3 males and 1 female. Three cases of partial laparoscopic resection of the cecum and 1 case of ileocecal resection with lymph node dissection were performed. The pathology was low-grade mucinous neoplasm in all cases. The median hospital stay was 6 days, and there were no postoperative complications(CD Grade 3 or higher)or hospital death. As for long-term results, peritoneal pseudomyxoma developed in 1 case, which had already ruptured at the time of surgery. There were no recurrences in other cases. This result suggests that laparoscopic surgery for appendiceal mucinous neoplasm is safe with optimal selection of the procedure and a protective technique.
要旨
虫垂粘液産生腫瘍は良性腫瘍に分類されるが,穿破を契機に腹膜偽粘液腫を来すリスクがあり,腹腔鏡下手術の安全性は確立されていない。当科関連施設で虫垂粘液産生腫瘍に対して腹腔鏡下手術を行った4例を後ろ向きに調査した。年齢の中央値は69.5(49～85)歳,男性3例,女性1例であった。術式は盲腸部分切除3例,リンパ節郭清を伴う回盲部切除が1例。1例で腹腔内観察時,すでに穿破および周囲への腹膜偽粘液腫を認めたが,その他の症例において術中操作による穿破はなかった。病理診断は全例で低異型度虫垂粘液性腫瘍(low-grade mucinous neoplasm)であった。術後合併症(Clavien-Dindo分類Grade 3以上)は認めず,在院日数の中央値は6日であった。長期成績は,手術時すでに穿破していた1例を除き再発を認めなかった(観察期間中央値14.8か月)。虫垂粘液産生腫瘍に対する腹腔鏡下手術は,選択肢の一つになり得ると考えられる。さらなる症例集積が必要である。