巨大肝囊胞に対しS.A.N.D.バルーンカテーテルを用いて腹腔鏡下肝囊胞天蓋切除術を施行した1例

A case of laparoscopic deroofing of a giant hepatic cyst using a S.A.N.D. balloon catheter

◆要旨：症例は65歳，女性．巨大肝囊胞感染のため入院加療となった．腹部CTで最大径33cmの巨大肝囊胞を認め，抗菌薬投与ののち第17病日に腹腔鏡下肝囊胞天蓋切除術を施行した．臍部に2cmの小切開を置き，S.A.N.D.バルーンカテーテルを用いて肝囊胞を穿刺し，計11.7Lを排液した．排液速度は7.8L/時であり，その間に呼吸や循環動態の破綻はきたさなかった．肝囊胞は肝外側区域より発生しており，囊胞壁は開窓して天蓋切除とした．腹腔内を占拠する巨大肝囊胞に対して，腹腔鏡下手術を安全に施行するには，呼吸・循環動態の把握と，術野の確保が必要である．S.A.N.D.バルーンカテーテルを用い，排液速度を適切に設定することで，有効かつ安全に手術が可能となった．

　A 65-year-old woman was admitted for treatment because of an infected giant hepatic cyst. Abdominal CT revealed a giant hepatic cyst measuring up to 33cm in diameter. Antibiotic therapy was initiated, and laparoscopic deroofing was performed on hospital day 17. A 2-cm umbilical incision was made, and the cyst was punctured using a S.A.N.D. balloon catheter. A total of 11.7 liters of cyst fluid was aspirated at a rate of 7.8L per hour. No respiratory or hemodynamic instability occurred during the procedure. The cyst originated from the left lateral section of the liver, and deroofing was completed after sufficient decompression. The appropriate use of the S.A.N.D. balloon catheter, with proper adjustment of drainage rate, contributed to a safe and effective surgical outcome.