クモ膜囊胞-腹腔内シャントを留置された高度肥満患者に対する単孔式腹腔鏡下胆囊摘出術

Single-incision laparoscopic cholecystectomy for a morbid obese patient with arachnoid cyst-peritoneal shunt

◆要旨：患者はBMI 35.9kg/m²と高度肥満の29歳，女性．14歳時に後頭蓋窩クモ膜囊胞に対してクモ膜囊胞-腹腔内シャント（以下，APS）を留置されている．2010年9月に胆石性胆囊炎を発症したが他院での保存的加療により軽快した．同年10月，単孔式腹腔鏡下胆囊摘出術（以下，SPS-LC）を希望し当院を受診した．APSチューブは右後頭部から右頸部，右胸腹部の皮下を走行し，右下腹部で腹腔内に入っていた．チューブ先端は骨盤内左側にあった．APSは逆流防止機能を有していたため特に処置は行わず，10mmHgの気腹下に単孔式腹腔鏡下胆囊摘出術を行った．経過は良好で，術後3日目に軽快退院となった．APSを留置された高度肥満例に対してもSPS-LC を安全に行えた症例を経験したので報告する．

　The patient is a 29-year-old woman who underwent implantation of an arachnoid cyst-peritoneal shunt (hereinafter referred to as APS) for a posterior fossa arachnoid cyst at the age of 14 years. At her visit to our hospital, she was morbidly obese with a body mass index of 35.9kg/m². Although chololithic cholecystitis occurred in September 2010, it was relieved by conservative treatment given at another hospital. In October of the same year, she visited our hospital, requesting a single-incision laparoscopic cholecystectomy. The APS tube was routed from the right occiput, subcutaneously through the right neck and right thoracoabdominal region, into the abdominal cavity at the right lower abdomen. The tip of the tube was located in the left side of the pelvis. While no specific measure was taken for the APS because it was equipped with antireflux function, we performed single-incision laparoscopic cholecystectomy with 10-mmHg pneumoperitoneum. The postoperative course was favorable, and she was discharged with recovery on the 3rd postoperative day.