大腸癌合併家族性大腸腺腫症の肝転移に対して用手補助腹腔鏡下肝部分切除術を行った1例

Laparoscopic partial hepatectomy for liver metastasis in familial adenomatous polyposis complicated by colorectal cancer : a case report

◆要旨：患者は19歳，女性．大腸癌合併家族性大腸腺腫症で腹腔鏡下大腸全摘術，小腸人工肛門造設を行った．その後，肝転移を認めBevacizumab＋FOLFOXを施行後，用手補助腹腔鏡下肝部分切除術を行った．初回手術時の人工肛門創を有効利用し腹腔内に術者左手を挿入することで適切な用指止血と術野展開を行い， LigaSure^TM VによるForceps fracture methodで出血制御しながら肝実質切離を行った．経過良好で術後12日目に退院した．人工肛門創から用手操作することで安全に用手補助腹腔鏡下肝部分切除術を施行し，低侵襲性と整容性を保持できた症例を経験したので報告した．

　The patient was a 19-year-old female with familial adenomatous polyposis complicated by colorectal cancer who had undergone laparoscopic total proctocolectomy and creation of an enterostomy. Liver metastasis was later discovered, and she was treated with bevacizumab＋FOLFOX and by hand-assisted laparoscopic partial hepatectomy in two stages. The surgeon performed appropriate digital hemostasis and exposure of the surgical field by effective use of the enterostomy wound created during the initial operation and inserting the left hand, and the hepatic parenchyma was being dissected while bleeding was controlled by the forceps fracture method with LigaSure^TM V. The patient's course was favorable, and she was discharged on postoperative day 12. From the standpoint of effective use of the wound, this surgical procedure seems to be appropriate for 2-stage surgery after laparoscopic total proctocolectomy, and since minimal invasiveness and cosmesis appeared to have been achieved, we report the case together with a discussion based on the literature.