胆囊胆管瘻を伴うMirizzi症候群と胃癌に対して同時腹腔鏡下手術を行った1例

Simultaneous laparoscopic treatment of Mirizzi syndrome with cholecystocholedochal fistula and gastric cancer : a case report

◆要旨：患者は50歳代，男性．胃癌，胆石症の精査のため当科を受診した．術前精査にて早期胃癌とMirizzi症候群と診断し，腹腔鏡下手術を行った．術中所見では胆囊胆管瘻を伴うMirizzi症候群と診断したが，腹腔鏡下に対応可能であった．さらに胃癌に対してリンパ節郭清を伴う完全腹腔鏡下幽門側胃切除を施行した．術後は問題なく経過し，術後12日目に軽快退院となった．Mirizzi症候群に対する腹腔鏡下手術は高難度手術とされ，さらに胃癌との腹腔鏡下同時手術の報告はない．手術時間や安全性など，まだまだ課題が多い術式ではあるが，貴重な1例と考え報告する．

　A man in his fifties was admitted to our hospital with a diagnosis of early gastric cancer and cholelithiasis. Laparoscopic treatment was performed with a diagnosis of early gastric cancer and Mirizzi's syndrome. Intraoperative finding showed Mirizzi's syndrome with cholecystocholedochal fistula. Under totally laparoscopic approach, treatment for Mirizzi's syndrome was successfully performed. Furthermore, total laparoscopic distal gastrectomy with lymphadenectomy was performed without any problem. The postoperative course was uneventful and the patient was discharged 12 days after surgery. There is no case report for simultaneous laparoscopic treatment of Mirizzi's syndrome and gastric cancer.