脳室-腹腔シャント留置中の患者に対する腹腔鏡下胆囊摘出術の経験―簡易的逆流実験と文献的考察による安全性の検討―

Laparoscopic cholecystectomy in a patient with ventriculoperitoneal shunt based on a valve experiment for the back pressure of CO2 insufflation model

◆要旨：脳室-腹腔シャント（以下，VPS）留置中患者に腹腔鏡下手術を行う場合には腹腔内圧の上昇によるシャントトラブルの可能性を懸念せざるをえない．筆者らはVPS留置後8年目の60歳代，女性に腹腔鏡下胆囊摘出術を予定した．術前にVPSバルブの簡易的な逆流試験を行い安全な耐圧を確認し手術を施行した．術前にシャントチューブの走行を確認し，瘻孔ごとクランプして気腹した．シャントチューブは腹腔内左寄りに留置しており大網で隔てられていた．腹腔鏡下に胆囊を摘出し気腹を解除した後にクランプを解除した．術後は合併症なく13日目に退院した．シャントバルブの特性を活かし感染対策をとれば，VPS留置患者における腹腔鏡下手術は安全に施行できるものと思われた．

　If a patient with ventriperitoneal shunt（VPS）undergoes laparoscopic surgery, surgeons consider a possibility of impaired VPS because of increased intraabdominal pressure. A patient with VPS for eight years was planned to receive laparoscopic cholecystectomy. We performed an easy experiment of the facility of the VPS valve and confirmed that it can withstand the pressure safely. The VPS tube was clamped along with the fistula before CO 2 insufflation. The VPS tube was found in the left side of the abdominal cavity, and it was separated by the great omentum. After the gallbladder was successfully resected and CO 2 was desufflated, the clamping of VPS tube was released. The patient was discharged uneventfully on the post operative day 13. We believe that laparoscopic surgery can be performed safely in selected patients with VPS.