腹膜透析患者に対して腹腔鏡下胆囊摘出術を施行した1例

A patient receiving peritoneal dialysis who underwent laparoscopic cholecystectomy

◆要旨：患者は58歳，男性．既往歴は大動脈解離（DeBakey IIIb），高血圧，心房細動，脊椎炎，慢性腎炎より腎不全に至り腹膜透析中であった．上腹部痛を主訴に近医を受診し，胆囊炎，胆石症と診断された．その後も腹痛を繰り返したため当院腎臓科に紹介となった．患者が術後も腹膜透析治療の継続を強く希望したため，前腕にシャント造設後に施行する方針とし，外科に紹介となった．手術時間は1時間45分，出血量は15mlで損傷なく終了し，術後1年4か月経過した現在も順調に腹膜透析治療中である．腹膜透析患者に対して腹腔鏡下手術を施行された症例はほとんどなく，今回，筆者らは貴重な症例を経験したため術後経過も含めて報告する．

　A 58-year-old male had a history of spondylitis. He had received peritoneal dialysis due to renal failure. He consulted a local clinic with upper abdominal pain, and was diagnosed with cholecystitis and cholelithiasis. Subsequently, abdominal pain repeatedly recurred, and the patient was referred to the Department of Nephrology in our hospital. As the patient wished to continue peritoneal dialysis after surgery, laparoscopic cholecystectomy following shunt formation in the forearm was selected. The patient was referred to the Department of Surgery. The duration of surgery was 1 hour and 45 minutes. The volume of blood loss was 15 ml. Surgery was completed without injury. During the 16-month postoperative follow-up, peritoneal dialysis has been favorably performed. There are few case reports on laparoscopic surgery in patients receiving peritoneal dialysis. In this study, we report this patient along with the postoperative course.