腹腔鏡補助下に一期的に生体部分肝移植と付属器切除を施行した1例

A case of living-donor liver transplantation by hand-assisted laparoscopic surgery combined with laparoscopic salpingo-oophorectomy

◆要旨：患者は57歳，女性．非代償性C型肝硬変に対する生体肝移植を目的に紹介された．腹部CTにて卵巣腫瘍を認め，良性もしくは境界悪性病変の診断で，付属器切除手術適応と判断された．そこで，腹腔鏡下付属器切除を施行後，一期的に腹腔鏡補助下による生体肝移植手術を立案した．上腹部正中切開8cmで開腹し，気腹下hand-assisted laparoscopic surgery（以下，HALS）にて婦人科手術で挿入したポートを用い，肝・脾を授動した後に正中創を12cmまで延長し，直視下に脾摘，肝全摘を行った．肝静脈吻合，門脈吻合，肝動脈吻合，胆道再建を同創より直視下に行い，手術を終了した．腹腔鏡補助下手術との組み合わせにより，今回のような重複疾患に対しても，低侵襲かつ安全な手術が可能であった．

A 57-year-old woman with a decompensated liver cirrhosis due to hepatitis C was referred to our hospital for living donor liver transplantation. During the preoperative work-up CT showed an ovarian tumor that was indicated for resection. We planned simultaneous ovarian tumor resection and living-donor liver transplantation. Firstly, ovarian tumor was laparoscopically resected, subsequently living-donor liver transplantation and splenectomy were performed by hand-assisted laparoscopic surgery and short upper midline laparotomy. By applying laparoscopic surgery, we safely performed a living-donor liver transplantation which was complicated with a disease in another organ.