再発肝囊胞に対して腹腔鏡下肝囊胞天蓋切除術を施行した2例

Laparoscopic deroofing for two cases of recurrent liver cysts

◆要旨：肝囊胞に対する腹腔鏡下肝囊胞天蓋切除術（laparoscopic deroofing：以下，LD）施行後に再発する症例が報告されている．LD施行後再発肝囊胞に対して再LDを施行した2例を報告する．1例目は60歳，女性．肝左葉外側域の径12cmの囊胞に対してLDを施行したが同部位に径10cmの囊胞が再発したため，再LDを施行した．1年後，同部位に径7cmの囊胞が再発したが無症状である．2例目は57歳，女性．肝右葉前区域の径15cm，左葉S4の径9cmの囊胞に対してLDを施行したが，肝右葉前区域に径15cm囊胞が再発したため，再LDを施行し，その後再発は認められない．LDの合併症が少なく低侵襲であることを考慮すると，肝囊胞に対するLD後の再発に対しては再LDを施行する意義が十分あると考えられた．

　Recurrent liver cysts sometimes develop after laparoscopic deroofing （LD）. We herein report two patients who developed recurrent liver cysts after LD and who were treated by re-LD. Patient 1 : A 60-year-old female with a 12cm cyst located in the lateral segment of the left lobe of the liver had been treated by LD. A 10cm cyst recurred in the same segment, and was treated by re-LD. She has been asymptomatic since the re-LD, however a 7 cm cyst recurred again in the same segment. Patient 2 : A 57-year-old female with a 15 cm cyst located in the anterior segment of the right lobe of the liver and a 9 cm cyst located in the segment 4 of the left lobe had been treated by LD. A 15cm cyst recurred in the anterior segment of the right lobe of the liver, and was treated by re-LD. She has had no subsequent cyst recurrence. Conclusion : Given the lower invasiveness and fewer complications associated with LD, recurrent liver cysts after LD should be treated by re-LD.