脳室-腹腔シャント留置例に対し腹腔鏡下低位前方切除術を施行した1例

Laparoscopic anterior resection for advanced rectal cancer patient withventriculoperitoneal shunt : a case report

◆要旨：患者は66歳女性で，便秘および血便を主訴に受診した．精査にて上部直腸癌と診断した．くも膜下出血の既往があり，続発性水頭症に対し，脳室-腹腔シャント留置術が施行されていた．術前に，シャントチューブの走行を確かめ，留置シャントが圧可変式バルブによる逆流防止機構付きであり，通常の気腹圧での腹腔鏡下手術が可能であると判断した．術中は，シャントチューブを術野から遠離した後に，通常気腹圧下でD3郭清を伴う低位前方切除術を施行した．術後経過は良好で第13病日独歩退院した．あらかじめシャントの走行や閉塞，逆行性感染などの合併症に留意する必要があるが，逆流防止機構付きの脳室-腹腔シャント例においては，腹腔鏡下手術は通常気腹下で施行可能であると考えられた．

The patient was a 66-year-old woman. She visited our hospital with complaints of constipation and hematochezia. Colonoscopy revealed an advanced cancer in upper part of the rectum. The patient had a past history of subarachnoid hemorrhage and had undergone ventriculoperitoneal shunt operation for secondary hydrocephalus. Before the surgery for rectal cancer, the route of the shunt tube with anti-reflex valve was confirmed. We concluded that laparoscopic surgery under common pneumoperitoneum pressure was possible with this programmed valve shunt system. During surgery, the shunt tube was moved away from the operative view. The laparoscopic low anterior resection with D3 LN dissection was safely performed under common pneumoperitoneum pressure. On 13th hospitalized day, the patient was discharged without any complication. In patients with advanced colorectal cancer who had been treated previously by ventriculoperitoneal shunt tube with pressure control valve, laparoscopic surgery under common pneumoperitoneal pressure is a safe treatment.