7年の腹膜透析歴のある患者に対する単孔式腹腔鏡下胆囊摘出術の経験

Single-incision laparoscopic cholecystectomy for a patient who had received peritoneal dialysis for 7 years

◆要旨：7年の持続携行式腹膜透析（CAPD）歴のある患者に対し，単孔式腹腔鏡下胆囊摘出術を施行したので報告する．患者は血液透析を施行中の70歳男性．嘔吐を訴えたため精査を行ったところ胆囊結石症と診断された．右上腹部から刺入した細径鉗子を併用して単孔式腹腔鏡下胆囊摘出術を施行した．腹腔内は広範囲に繭状の癒着を認めたが安全に剝離可能で，胆囊管および胆囊動脈は確実に処理可能で単孔式腹腔鏡下に手術を完遂した．術後経過は良好で7日目に退院となった．CAPDを長期間施行すると腹腔内の癒着が発生するため腹部手術は困難で腹腔鏡下手術を行った報告は少ないが，単孔式手術ならではのメリットもあるため選択肢の1つとして考慮すべきと思われた．

　A 70-year-old man on hemodialysis who has a previous history of receiving continuous ambulatory peritoneal dialysis（CAPD） for 7 years complained of vomiting. He was diagnosed as having cholecystolithiasis, and underwent single-incision laparoscopic cholecystectomy. During surgery, a slim needle forceps was used in combination in order to keep better operative field. Because of his long-term history of receiving CAPD, broad and expansive intraabdominal adhesion was spread to the entire abdomen. However, single-incision laparoscopic cholesytectomy was successfully performed in the usual manner including secure ligation of the cystic duct and the cystic artery after laparoscopic safety removal of intraabdonimal adhesion. He was discharged 7 days after surgery without any complications. The abdominal surgery, especially laparoscopic surgery after long-term CAPD is generally considered to be difficult since CAPD dialysate induces peritoneal fibrosis resulting in intraabdonimal adhesion. This is the first report describing the usefulness of single-incision laparoscopic cholecystectomy for patients with a history of CAPD.