腹腔鏡下肝囊胞開窓術―1年以上の長期経過からみた有用性―

Laparoscopic fenestration of nonparasitic liver cysts : long term results

◆要旨：腹腔鏡下肝囊胞開窓術（laparoscopic fenestration：LF）は，部位により開窓や囊胞内腔の焼灼処理，また脈管走行確認や止血処理の難度が異なる．LF施行後1年以上経過した12症例について，上記のような観点を中心にLFの有用性を検討した．単純性囊胞の8例中3例が焼灼不十分，1例が開窓不十分（再開窓例），また1例が胆管の走行を確認し得なかった．しかしながら，内腔焼灼の不十分例も1年後は特に囊胞再発はみられず良好な経過であった．Adult polycystic liver disease（APLD）4例の場合，術前より腎機能低下例では腹満が継続し症状緩和が得がたい症例もみられたが，腎機能保持例では，その後約3年間の症状緩和と腹囲減少が得られた．長期的にみてLFは，単純性囊胞に対してはピットフォールを理解して行えば有用な手術法である．APLDに対しては，腎機能の保持が手術選択の一指標と考えられた．

　The outcomes of laparoscopic fenestration were reviewed in 12 patients who had been followed for more than 1 year after the procedure. Among the 12 patients, 8 patients had simple large cysts（Simple）and 4 patients had adult polycystic liver disease（APLD）. The average number of fenestrated cysts was 1.7 and 6-20 for Simple and APLD groups, respectively. The average time of surgery was 3.2 hours. In 3 patients with simple cysts, the cauterization was inadequate and the mean drainage volume was 380 ml on the 5th postoperative day. However, after the drain had been removed, there was no problem and the cyst did not recur. The fenestration of the upper liver area was inadequate in 1 patient, and re-fenestration was necessary because of the recurrent cyst. In another patient, left hepatic lobe was resected because the left hepatic duct ran solely on the surface of the large cyst and it was injured as a complication of the fenestration.

　For APLD patients with decreased renal function, abdominal distention did not ameliorate easily. However, for patients whose renal function was preserved, the abdominal distention was better and the symptoms relaxed for approximately 3 years after the procedure. Laparoscopic fenestration is useful for patients with simple large cysts, if the pitfall of the procedure is understood. For patients with APLD, the procedure may be useful when the patients'renal function is preserved.