肝円索位置異常を伴う部分内臓逆位に併存した胆囊癌に対して腹腔鏡下胆囊全層切除術を施行した1例

Laparoscopic whole layer cholecystectomy in a patient with situs inversus partialis and a right-sided round ligament : A case report

◆要旨：症例は76歳，女性．肺炎の診断時のCTで胆囊腫瘤性病変を指摘され，当科紹介となった．画像上，部分内臓逆位にいわゆる解剖正位でいう右側肝円索を伴い，さらに十二指腸前門脈，十二指腸前総胆管，腸回転異常症，膵尾部欠損，膵管癒合不全，多脾症を合併していた．早期胆囊癌を疑い，腹腔鏡下胆囊全層切除術を施行し，最終病理で胆囊癌の診断を得た．内臓逆位と右側肝円索の併存により，肝円索や肝十二指腸間膜と胆囊，胆囊管の位置関係は正位と同様となり，ポート配置の工夫により患者左側から通常の胆囊摘出に近い操作で手術を終えることができた．右側肝円索を伴う部分内臓逆位に併存した胆囊癌の手術報告はなく，文献的考察を加えて報告する．

　The patient was a 76-year-old woman diagnosed with a gallbladder tumor on computed tomography. She also had situs inversus partialis with a right-sided round ligament, as well as preduodenal portal vein and common bile duct, intestinal malrotation, agenesis of the pancreatic tail, pancreas divisum, and polysplenia. Preoperative diagnosis of early-stage gallbladder carcinoma was made, and laparoscopic whole layer cholecystectomy was performed. The final histopathological examination revealed gallbladder cancer invading muscularis propria. With the coexistence of situs inversus partialis and a right-sided round ligament, the anatomical variation around hepatoduodenal ligament was similar to that of normal anatomy. By adjusting the placement of surgical ports, the procedure was successfully completed with conventional cholecystectomy maneuvers as the operator standing on the patient's left side. To our knowledge, this is the first report of a gallbladder cancer in a patient with situs inversus partialis complicated by a right-sided round ligament. Herein, we present this case along with a review of the literature.