胃と腸49巻4号

2014年04月発行

今月の主題 虫垂病変のすべて―非腫瘍から腫瘍まで 主題研究

虫垂病変の臨床―腹膜偽粘液腫の診断および治療方針

著者： 矢野秀朗¹ 合田良政¹ 須田竜一郎¹ 猪狩亨²

所属機関： ¹国立国際医療研究センター外科・下部消化管外科 ²国立国際医療研究センター中央検査部・臨床病理室

ページ範囲：P.520 - P.526

要旨　腹膜偽粘液腫はまれな疾患で，典型的には低異型度虫垂粘液癌が穿孔し，腹腔内に多量の粘液が貯留する．血行性・リンパ行性転移を来すことはまれだが，放置すると次第に進行し，致死的となる．病理学的にも臨床的にもlow-gradeとhigh-gradeに分類されることが多いが，その生物学的悪性度は広い幅を有する．虫垂粘液腫瘤の非穿破例においては，診断と治療を兼ねた早期の切除が望まれる．腹膜偽粘液腫に対しては，腹膜切除を伴う完全減量切除と術中腹腔内温熱化学療法の組み合わせが，今や標準治療として確立している．わが国においても今後，センター化による症例の蓄積を図ることにより，病態のさらなる解明と治療成績の向上が望まれる．

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