乳児後天性結腸狭窄に対して経肛門的にEndo PeanutTMを用いたreduced port surgery への工夫

Ingenuity for reduced port surgery utilizing transanal laparoscopic forceps for infantile acquired colonic stenosis : A case report

◆要旨：［症例］3か月，女児．25週1日，830gにて出生．患児は生直後より循環不全状態が遷延していた．ミルクは日齢1より経鼻胃管から投与開始されたが，日齢90より著明な腹部膨満を呈すようになった．注腸造影を施行すると，下行結腸に全周性の狭窄部位を認めた．径5mmの3ポートにて腹腔鏡下手術を施行すると，下行結腸に全周性狭窄部が存在した．経肛門的にEndo Peanut^TMを下行結腸まで挿入し，これを牽引しながら狭窄部結腸周囲を処理した．狭窄部腸管は臍部ポート創からの腹腔外操作で切除および吻合を行った．術後経過は良好であった．［結論］経肛門的Endo Peanut^TMは小児の下行結腸から直腸の腹腔鏡下手術に対するreduced port surgeryとして有用であると考えられた．

A female infant, born at 25 weeks and 1 day of gestation and weighing 830g, suffered from inadequate circulation after birth. She was given milk via a nasogastric tube since day one. However, she suffered from significant abdominal distention when she was 90 days old. An enema x-ray examination revealed a stenotic lesion at the descending colon. Laparoscopic surgery was performed via three ports. The stenotic lesion at the descending colon was detached laparoscopically by manipulating laparoscopic cotton swab bar （Endo Peanut^TM） via the transanal route and the lesion was resected extraperitoneally by utilizing the umbilical port wound. The postoperative course was uneventful. Transanal laparoscopic cotton swab bar is useful as a reduced port surgery from the descending colon to the rectum in children.