急性胆囊炎合併ventriculoperitoneal shunt留置患者に対する腹腔鏡下胆囊摘出術の経験

Laparoscopic cholecystectomy in a patient of acute cholecystitis with a ventriculoperitoneal shunt

症例は69歳，男性．食欲不振・発熱を主訴に急性胆囊炎の診断にて入院・加療となった．既往歴は，57歳時に水頭症に対してventriculoperitoneal shunt（VPS）留置術を施行されていた．保存的加療は困難と判断し，胆囊結石症および急性胆囊炎の診断で腹腔鏡下胆囊摘出術を施行した．全身麻酔下にまずVPSチューブをクランプした後に，4ポート，CO₂気腹法（最大圧10mmHg）で行った．術直後，術後3日目の頭部ＣＴ検査でも気脳症は認めなかった．肝床下に留置したドレーンから胆汁漏がないのを確認した後，ドレーン抜去およびVPSチューブのクランプを中止した．以後の経過は良好であった．本症例のように，チューブのクランプおよび気腹圧の調節で安全に腹腔鏡下手術が施行できると考えられた．

　A 69-year-old man with ventriculoperitoneal shunt（VPS）had gallstones and acute cholecystitis. We performed laparoscopic cholecystectomy with a standard 4-port access. The abdomen was minimally insufflated to allow clamping of the VPS distal catheter with atraumatic forceps ; after clamping, the CO₂ insufflation pressure was increased to 10 mmHg. The peritoneal cavity was free of adhesions, but the gallbladder was closely adherent to the liver and the greater omentum. The rest of the procedure was uneventful with no signs of increased intracranial pressure. The patient recovered well postoperatively, with neither signs of neurological squeal nor any signs of shunt failure or infection. We reported how we managed a hydrocephalic adult with a VPS undergoing laparoscopic cholecystectomy in the hope that our experience contributes to the successful management of such patients in the future.