左側胆囊結石症に対して手技の工夫により安全に腹腔鏡下手術を施行しえた1例

Left-sided gallbladder treated by laparoscopic cholecystectomy : a case report

◆要旨：患者は36歳，女性．心窩部痛の精査で行った腹部超音波検査で胆石症と診断された．腹部MRIでは胆囊内に結石を認め，胆囊床が肝円索の左側に位置する左側胆囊を認め，腹腔鏡下胆囊摘出術を施行した．手術時，①心窩部のポートを通常より左側に挿入する，②肝円索を腹壁に固定する，③Calot三角の展開の際には胆囊屈曲部を把持して右頭側に引き上げる，④胆囊底部の胆囊切離に際して術者の立ち位置を患者右側に変えて切離を行う，などの工夫を行った．左側胆囊の場合，胆管や血管の走行異常が合併することも多く，これらの損傷に注意した慎重な剝離操作が必要となるが，上記の点を工夫することで安全な手術操作が可能である．

　We report a case of left-sided gallbladder（LSG）treated by laparoscopic cholecystectomy（LC）. A 36-year-old woman with cholelithiasis was admitted to our hospital. Magnetic resonance imaging revealed gall bladder stones with LSG, and LC was performed. Intraoperative findings showed that the fundus of gallbladder was adhered to the liver bed at left side of the hepatic round ligament. For safe LC in patients with LSG, we made following efforts. First, 5 mm port at subxiphoid was placed more on the left side than usual. Secondly, the round ligament was retracted by a thread fold via the abdominal wall. Thirdly, the body of the gallbladder was retracted to the right cranial side to expose the Calot's triangle. Finaily, the operator stood on the right side of the patient while dissecting the fundus of the gallbladder. A LSG is often associated with anomalies of the bile duct, artery and portal vein. When performing LC for LSG, we must take extra care to avoid the bile duct and vessel injury.