単孔式内視鏡外科手術にて肝部分切除を施行した肝細胞癌の1例

Partial hepatic resection by single-incision laparoscopic surgery for hepatocellular carcinoma : a case report

◆要旨：単孔式内視鏡外科手術による肝切除の1例を報告する．C型肝硬変を有する75歳，女性の肝外側区域に1.5cmの肝細胞癌を認めた．臍部を3cm小切開して専用ポートを留置し，5mmのトロッカーを3本挿入した．腹腔鏡用超音波にて腫瘍部位と切離線を確認し，ロティキュレーター把持鉗子とvessel sealerにて肝実質切離を行った．切除肝の牽引にループリトラクターを利用しながら肝部分切除を完遂し，切除肝をポート部より摘出した．手術時間167分で出血は少量であった．術後経過は良好で臍部の疼痛は軽微であった．本法を用いることでより傷が目立たず創痛の少ない低侵襲手術が可能である．

　We reported a case of partial hepatic resection by single incision laparoscopic surgery（SILS）. A 75 year-old woman with hepatitis C cirrhosis was diagnosed with hepatocellular carcinoma 1.5 cm in size in the left lateral segment. Single port laparoscopic hepatectomy was scheduled. The navel was incised 3 cm and a single port was placed accompanied with 3 trocars. Under observation using 5 mm of flexible laparoscopy, location of a tumor and surgical margin were confirmed by ultrasonography. Transection of hepatic parenchyma was easily accomplished using reticulated grasping forceps, vessel sealing device and loop retractor. The specimen was retrieved via the port site. Postoperative course was uneventful and the pain of the navel wound was mild. This procedure may allow hepatic resection with minimal wound and pain.