腹腔鏡下摘出術を施行した胃平滑筋芽細胞腫の1例 A CASE OF LAPALOSCOPICALLY RESECTED GASTRIC LEIOMYOBLASTOMA

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胃粘膜下腫瘍には各種の疾患があるが,平滑筋芽細胞腫は比較的稀である.腫瘍が小さい場合,臨床的に平滑筋腫,平滑筋肉腫などとの鑑別が難しい.治療としては悪性の場合を考え予防的にリンパ節郭清を伴う胃切除が主に行われており,局所切除は少ない.われわれは39歳男性の胃後壁の粘膜下腫瘍を平滑筋腫と術前診断し,腹腔鏡下に腫瘤を含む胃部分切除を行った.摘出標本の病理所見で平滑筋芽細胞腫と診断されたが,核分裂像は認められず良性と判断し追加手術は行わなかった. 1年4カ月後の検査でも胃の変形や再発を認めず,術前と同様の生活の質を維持している.術前の良・悪性の確定診断が難しい比較的小さな胃粘膜下腫瘍に対しては,まず手術侵襲の小さい腹腔鏡下切除を行い,病理検査で悪性と診断された場合に,根治術を追加とし,良性で根治術追加の不必要な胃切除術を避ける一方法と思われる.

This paper describes a case of laparoscopically resected leiomyoblastoma, with a review of the literature. A 39-year-old man was found having a submucosal tumor (SMT) in the posterior wall of the stomach. It was diagnosed as leiomyoma preoperatively. Laparoscopic local excision of the stomach including the tumor was carried out. Pathological diagnosis of the resected apecimen was leiomyoblastoma, but mitotic figures were lacked. We evaluated the tumor asbenign and did no additional operation. Recent examination one year and four months after the laparoscopic operation showed no gastric deformity nor sign of recurrence. The patient's quality of life is the same as before the operation.<br> Leiomyoblastoma is a rare tumor among various gastric SMTs. If it is small in size, the differential diagnosis from leiomyoma of leiomyosarucoma is difficult to make. Therapy of leiomyoblastoma usually comprises prophylactic lymphadenectomy and gastrectomy, considering the malignancy. Local resection is rarely performed. Howerver, for small gastric SMTs of with preoperative diagnosis whether benign or malignant is difficult, the treatment of choise may be a minimal invasive laparoscopic resection first, and if pathological diagnosis is malignant, additional radical operation is followed. Such strategy will spare unnecessary gastorectomies.

収録刊行物

  • 日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society

    日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society 57(2), 379-383, 1996-02-25

    日本臨床外科学会

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各種コード

  • NII論文ID(NAID)
    10008519108
  • NII書誌ID(NCID)
    AN00198696
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    03869776
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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