腹腔鏡下瘻孔切除術が有用であった空腸瘻抜去後の難治性瘻孔の1例

A case of postoperative enterocutaneous fistula treated by laparoscopic surgery

◆要旨：患者は64歳，女性．早期胃癌に対して腹腔鏡下胃全摘術（R-Y再建）を施行した．術後2日目に横隔膜ヘルニアを発症し，腹腔鏡下ヘルニア修復術および空腸瘻造設を行った．術後7か月目，経口摂取が良好になり空腸瘻を外来にて抜去した．抜去部の瘻孔径は徐々に縮小したが閉鎖には至らず，腸液の流出が続き皮膚の発赤・びらん・疼痛などの皮膚障害を認めた．そのため，抜去から7か月目に，難治性瘻孔に対する腹腔鏡下瘻孔切除術を施行した．術後合併症はなく，術後10日目に退院し，皮膚障害は改善した．難治性瘻孔に対する腹腔鏡下瘻孔切除術に関する報告は，筆者らが検索しえた範囲ではないため報告する．

The patient was a 64-year-old woman who underwent laparoscopic total gastrectomy for early gastic cancer with Roux-en-Y reconstruction. Postoperatively, she underwent laparoscopic hernia repair for diaphragmatic hernia and construction of a low-profile button jejunostomy on the afferent limb for nutrition support. Seven months later, the button was removed because of improvement in nutritional status. Although the enterocutaneous fistula became smaller, enteric discharge persisted for the next seven months with signs of skin irritation such as redness, ulceration and pain. She underwent laparoscopic fistulectomy for intractable enterocutaneous fistula. The postoperative course was uneventful and the patient was discharged on postoperative day 10 with disappearance of the skin lesion. To our knowledge, this is the first report of laparoscopic surgery for postoperative enterocutaneous fistula.