肝細胞癌に対し単孔式腹腔鏡下肝部分切除術を施行した1例

Single port laparoscopic liver resection in a patient with hepatocellular carcinoma : a case report

◆要旨：患者は71歳，女性．CT検査で肝S6に1.5cmの濃染腫瘍を認め肝細胞癌と診断された．2010年9月，単孔式腹腔鏡下肝切除を施行した．臍直上にSILS^TMポートを挿入した．腫瘍は肝S6表面に突出していた．肝門部操作は行わず，超音波凝固切開装置，ソフト凝固電気メスを用いて腫瘍より十分なマージンをとって肝実質を離断した．切除標本は回収用バッグに入れて摘出した．手術時間2時間17分，出血量120mlであった．単孔式腹腔鏡下肝切除術は整容性に優れ，肝切除術においても有用な選択肢の1つとなりうる．本手術の施行にあたっては，内視鏡外科手術に習熟した術者と解剖学的に比較的容易に切除しうる症例に限定して行われるべきと思われる．

　We report our experience of a single port laparoscopic hepatic resection （SP-LHR） in a 71-year-old woman with a single 16 mm hepatocellular carcinoma （HCC）, who had undergone percutaneous radiofrequency ablation 2 years ago. A single 2.5cm incision was made in the supraumbilical area, and a SILS^TM Port was inserted. A 5-mm flexible endoscope was used. Liver resection was performed using laparoscopic ultrasonic shears and a soft-coagulation device. All procedures were successfully performed without conversion to conventional laparoscopic technique. The operative time was 137 minutes and intraoperative blood loss was 120ml.

SP-LHR provides better cosmetic outcome and could be one of the useful therapeutic choices. However, this procedure should be performed by an experienced endoscopic surgeons and it should be limited to those patients whose tumor site is relatively easy to remove anatomically.