Crohn病多発小腸狭窄に対して2度の単孔式腹腔鏡補助下小腸狭窄形成術を施行した1例

Single-incision laparoscopy-assisted strictureplasty performed two times for Crohn's disease with multiple strictures of small intestine : a case report

◆要旨：患者は23歳，男性．Crohn病に対して投薬加療中にイレウスを発症した．小腸造影で多発狭窄を認め，単孔式腹腔鏡補助下に4か所の狭窄形成術を行った．術後経過は良好で術後9日目に退院したが，約2年後イレウス再発をきたした．再度単孔式腹腔鏡補助下狭窄形成術（2か所）を行った．現在無症状で外来通院加療中である．今回Crohn病多発小腸狭窄に対して2度の単孔式腹腔鏡補助下小腸狭窄形成術を施行したが，癒着は皆無であった．複数回の手術を要することの多いCrohn病に対して，整容性，疼痛軽減，腹腔内の癒着防止の観点から，（単孔式）腹腔鏡下手術は有用な手技であると考えられたので，手技上の工夫も含め報告する．

A 23-year-old man treated with medication for Crohn's disease（CD） developed ileus. A small bowel enema examination showed multiple strictures. Single-incision laparocopy-assisted strictureplasty was performed on 4 lesions. The patient was discharged on postoperative day 9 without operative complications. Two years later, ileus recurred and the patient underwent single-incision laroscopic surgery again. Operative finding revealed no intraabdominal adhesion and 2 strictures were treated. He was discharged 8 days after the operation and is now free of symptoms. Most patients with CD require repeated surgery. Therefore, （single-incision） laparoscopic surgery which is less painful, shows lower possibility for intraabdominal adhesion, and presents smaller operative scars is considered to be a useful approach for CD. We report our experience and procedure of single-incision laparoscopy assisted strictureplasty.