腹腔鏡下に穿孔部へのTチューブ挿入が有効であった巨大十二指腸潰瘍穿孔の1例

A case of perforated duodenal ulcer treated by laparoscopic T-tube duodenostomy and omental patch repair

◆要旨：患者は83歳，女性．数日前から続く食欲不振と腹痛のため当院を受診した．腹膜刺激症状を認め，全身性炎症反応症候群の状態であった．腹部CTにて腹腔内遊離ガス像と腹水を認めた．腹腔鏡下に緊急手術を行い，十二指腸球部に巨大潰瘍穿孔がみられた．潰瘍穿孔部にTチューブを挿入し，さらに大網で被覆した．術後第21病日に経口摂取を開始し，術後第31病日にTチューブを抜去した．後日施行した上部消化管内視鏡検査では狭窄は認めなかった．消化管潰瘍症例で炎症が高度であり，穿孔径が大きい場合のTチューブ挿入は腹腔鏡下手術においても低侵襲・簡便であり，選択肢の1つとなりうると考えられた．

A 83-year-old woman was admitted for appetite loss and abdominal pain. Abdominal computed tomography showed a thickened wall of the duodenum, free air and ascites. The patient exhibited systemic inflammatory response syndrome and peritoneal irritation. Laparoscopy revealed a perforated duodenal bulb with purulent ascites. T-tube duodenostomy and omental patch repair were performed. On postoperative day （POD） 21, duodenography showed no leakage and T-tube drainage was clamped. On POD 31, T-tube was removed and she started oral feeding. On POD 43, she was discharged. A large duodenal ulcer perforation with a severe inflammatory change was treated effectively with T-tube duodenostomy and omental patch repair. To our knowledge, this is the first report of laparoscopic surgery with T-tube duodenostomy.