楯 真一

原発性卵巣腫瘍と転移性卵巣腫瘍では治療法や予後が異なるため鑑別が重要であるが,術前診断に苦慮する.今回,多房性嚢胞性腫瘍を呈した転移性卵巣腫瘍を2例経験した.症例1:81歳女性.X年6月に肝内胆管癌(高分化腺癌,Stage II)の手術を受けた.術後化学療法中のX+1年4月下腹部膨隆感があり,両側卵巣に多房性嚢胞性腫瘍を指摘され,当科紹介となった.MRI検査で粘液性腺腫が疑われ,腹腔鏡補助下両側付属器切除術を施行した.術後病理診断は肝内胆管癌の卵巣転移であった.症例2:37歳女性.Y年3月に肝内胆管癌(中〜高分化型腺癌,Stage IV)の手術を受けた.術後化学療法後,経過観察されていた.Y+1年6月に下腹部痛のため近医を受診し,卵巣嚢腫を指摘され当科紹介となった.超音波検査で両側卵巣に多房性嚢胞性腫瘤を認め粘液性腺腫を疑った.子宮頸部細胞診でAGCを検出したため,頸部と内膜組織診を施行し高分化型腺癌を検出した.肝内胆管癌の転移を疑い,子宮全摘+両側付属器切除術を施行した.術後病理診断は肝内胆管癌の卵巣・子宮転移であった.今回の2例のように,肝内胆管癌の卵巣転移は多房性嚢胞性腫瘍を呈する可能性があるため,肝内胆管癌既往の多房性卵巣腫瘍症例では,再発や転移の可能性を念頭におく必要があると考えられた.(著者抄録)

Objective. Locally advanced ovarian carcinomas may be fixed to the pelvic sidewall, and although these often involve the internal iliac vessels, they rarely involve the external iliac vessels. Such tumors are mostly considered inoperable. We present a surgical technique for complete resection of locally advanced ovarian carcinoma fixed to the pelvic sidewall and involving external and internal iliac vessels. Methods. A 69-year-old woman presented with ovarian carcinoma fixed to the right pelvic sidewall, which involved the right external and internal iliac arteries and veins and the right lower ureter, rectum, and vagina. We cut the external iliac artery and vein at the bifurcation and at the inguinal ligament to resect the external artery and vein. Then, we reconstructed the arterial and venous supplies of the right external artery and vein with grafts. After creating a wide space immediately inside of the sacral plexus to allow the tumor fixed to pelvic side wall with the internal iliac vessels to move medially, we performed total internal iliac vessel resection. Results. We achieved complete en bloc tumor resection with the right external and internal artery and vein, right ureter, vagina, and rectum adhering to the tumor. There were no intra-or postoperative complications, such as bleeding, graft occlusion, infection, or limb edema. Conclusion. Exfoliation from the sacral plexus and total resection with external and internal iliac vessels enables complete resection of the tumor fixed to the pelvic sidewall. (C) 2017 Elsevier Inc. All rights reserved.