単孔式腹腔鏡下胆囊摘出術を施行した門脈海綿状血管変形を伴う胆石症の1例

A case of single incision laparoscopic cholecystectomy for cholecystolithiasis with cavernous transformation of the portal vein

◆要旨：門脈海綿状血管変形は，慢性的な門脈閉塞により生ずる門脈周囲の海綿状血管腫様の側副血行路である．外科手術時には門脈海綿状血管の損傷は大量出血につながる可能性があり留意を要する．今回筆者らは，門脈海綿状血管変形を伴う胆石症に対する単孔式腹腔鏡下胆囊摘出術を経験した．患者は37歳の女性で，腹痛の精査にて門脈海綿状血管変形を伴う胆石症と診断した．術中所見では肝十二指腸間膜に門脈海綿状血管変形を認めたが，出血などの偶発症なく手術を施行しえた．腹腔鏡下手術における拡大視効果や良視野での繊細な操作性に加え，単孔式腹腔鏡下手術は整容性にも優れた術式であり，門脈海綿状血管変形を伴う胆石症に対しても有用であった．

Cavernous transformation of the portal vein is a collateral vessel simulating a cavanoma that results from chronic obstruction of the portal vein. Attention not to injure cavernous vessels should be paid during surgery. We performed single incision laparoscopic cholecystectomy for cholecystolithiasis with cavernous transformation of the portal vein. The case was 37-year-old woman with a complain of abdominal pain due to cholecystolitiasis. Although the vessels around hepatoduodenal ligament were enlarged and meandered, single incision laparoscopic cholecystectomy was performed safely without bleeding or complications. In addition to some advantages of laparoscopic surgery such as good surgical field view and its effect on precise surgical manipulation, single incision laparoscopic surgery has cosmetic benefits. The procedure was effective for cholecystolithiasis with cavernous transformation of the portal vein.