腹腔鏡下に修復した広汎型腰ヘルニアの1例

A case of diffuse lumbar hernia repaired by laparoscopic intraperitoneal procedure

◆要旨：腰ヘルニアは側腰部の解剖学的脆弱部位に発生する稀な疾患である．今回筆者らは，広汎型腰ヘルニアに対して経腹腔的に内視鏡下修復術を施行した．症例は74歳，女性．左腰部の不快感を主訴に受診した．腫瘤は触診上最大径15cm大であった．CT検査で頭側は左第12肋骨近傍，尾側は腸骨稜のすぐ近傍に至るまで，内腹斜筋と仙棘筋との間を開大するようにヘルニア門を認め，広汎型左腰ヘルニアと診断し手術を施行した．ヘルニア門は7×3cmであり，メッシュ固定と腹膜縫合閉鎖で修復した．広汎型腰ヘルニアに対する経腹腔的内視鏡下修復術は本症例が最初の報告であり，安全確実な術式として有用であると考えられた．

　Lumbar hernia is a rare type of abdominal wall defect over the lumbar triangles which is anatomically weak. We successfully repaired a diffuse lumbar hernia by laparoscopic intraperitoneal approach. A 74-year-old woman was referred to our department for a left lumbar bulging mass. A physical examination showed a reducible soft mass which was 15cm in diameter. Abdominal computed tomography revealed a left diffuse lumbar hernia, and we performed laparoscopic total intraperitoneal hernia repair. The hernia defect was found to be 3 by 7cm. We placed the mesh covering hernia orifice with suture, and secured the mesh using autosuture stapler. Laparoscopic intraperitoneal repair for a diffuse lumbar hernia provides an excellent operative view and minimal invasiveness. Our experience suggests that the laparoscopic intraperitoneal approach may be a feasible and safe alternative to conventional approaches in diffuse lumbar hernia repair.