遺伝性球状赤血球症に胆囊総胆管結石を合併した小児に対して腹腔鏡下脾摘術と胆囊摘出，総胆管切石術を施行した1例

A case report of simultaneous laparoscopic splenectomy, cholecystectomy and choledocholithotomy for hereditary spherocytosis with cholecysto-choledocholithiasis

症例は13歳の女児．遺伝性球状赤血球症にて経過観察中に腹痛と黄疸が出現し入院となった．腹部CT検査，腹部MRI検査の結果，胆囊結石と総胆管結石を認め，手術目的に当科に紹介となった．保存的に黄疸は軽減し，一期的に腹腔鏡下手術を施行することとした．まず仰臥位にて総胆管切石術および胆囊摘出術を行い，体位変換の後，脾臓摘出術を行った．手術時間は8時間27分と長時間を要したが，術後合併症は認めず，第9病日に外科退院となった．腹腔鏡下に胆囊摘出術，総胆管切石術および脾臓摘出術を一期的に行うことで患児への負担を最小限にし，かつ早期の退院を可能にすることができた．

　A 13-year-old girl who had hereditary spherocytosis was admitted to our hospital with symptoms of abdominal pain and icterus. Ultrasonography showed many gall bladder stones. Computed tomography and magnetic resonance image revealed three small stones in the common bile duct. Laparoscopic cholecystectomy, choledocholithotomy and splenectomy was performed simultaneously. Operation time was 8 hours and 27 minutes. The patient was discharged on the 9th postoperative day without any complications. Simultaneous laparoscopic treatment enabled reduction of the stress of the patient and helped shorten the length of hospital stay.