単孔式腹腔鏡下で修復しえた閉鎖孔ヘルニアの1例

A case of single incision laparoscopic repair of obturator hernia

◆要旨：患者は89歳，女性．嘔吐を主訴に紹介され入院した．腹部CT検査で左恥骨筋と左閉鎖筋の間に腫瘤陰影を認め，左閉鎖孔ヘルニア嵌頓の診断にて緊急手術を行った．術式は臍縦1.5cm切開によるマルチチャンネルポートを用いた経臍単孔式腹腔鏡下手術を選択した．腹腔内を観察すると左閉鎖孔に小腸の嵌頓を認めたが，鉗子を用いた愛護的な腸管の牽引にて解除しえた．ヘルニア門の修復は，ヘルニア囊を反転した後に周囲の腹膜を寄せて結節縫合する単純縫合閉鎖を行った．術後は経過良好で，創部痛もほとんど認めず早期離床，退院可能となった．高齢者に多い本疾患には低侵襲な単孔式腹腔鏡下手術が有用と考えられた．

　An 89-year-old woman was referred to our hospital for admission with the complaint of vomiting. An abdominal CT scan revealed a tumor mass in the area between the left peritoneal and left obturator muscles, and emergency surgery was performed after the diagnosis of an incarcerated left obturator hernia. Transumbilical single-incision laparoscopic surgery was performed using a multi-channel port which was inserted through a 1.5-cm vertical umbilical incision. An incarcerated small bowel was observed involving the obturator on the left side, and was reduced by gentle traction using forceps. For repair of the hernial orifice, the simple interrupted suturing technique, which closes the peritoneum after inverting the hernial sac, was performed. The patient's postoperative course was uneventful. She experienced only slight pain at the wound site, and quickly resumed favorable ambulation. Single-incision laparoscopic surgery is a minimally invasive approach which is considered effective for the treatment of elderly patients with this type of hernia.