胆管と交通を有した単純性肝囊胞に対し単孔式腹腔鏡下肝囊胞天蓋切除術にて治癒し得た1例

A case of liver cyst with biliary communication successfully treated with single incision laparoscopic deroofing

◆要旨：患者は75歳，女性．2010年9月下旬より突然右季肋部痛が出現し，当院を受診し，精査加療目的で緊急入院となった．入院後腹部超音波検査，腹部CT検査で，肝右葉を中心に20cm大の単純性肝囊胞を指摘された．経皮的ドレナージを施行したが，胆汁成分を含有した多量の囊胞液が吸引され，内視鏡下逆行性胆管造影では，肝内胆管と囊胞の交通が確認された．本症例に対して単孔式腹腔鏡下肝囊胞天蓋切除とともに，術中に囊胞腔内胆汁漏出部が同定されたため，その部を縫合・閉鎖した．術後，経過良好にて退院となった．今回，胆管と交通を有した単純性肝囊胞に対し単孔式腹腔鏡下肝囊胞天蓋切除術にて治癒し得た1例を経験したので報告する．

　The patient was a 75-year-old woman who visited our hospital for right hypochondrial pain which suddenly appeared in late September 2010.. Abdominal ultrasonography and CT detected a simple hepatic cyst measuring 20 cm in the right hepatic lobe. Percutaneous drainage was performed, and a large volume of fluid containing bile components was aspirated from the cyst.

On endoscopic retrograde cholangiography, the intrahepatic bile duct and hepatic cyst communicated. Single-incision laparoscopic deroofing of the hepatic cyst was performed, during which bile leakage into the hepatic cyst was identified, and the lesion was closed by suturing. After surgery, no bile leakage into the drain was observed, the patient recovered smoothly, and was discharged.