腹腔鏡下に子宮合併S状結腸切除を施行した結腸憩室炎に伴う結腸子宮瘻の1例

Laparoscopic sigmoidectomy combined with hysterectomy for colouterine fistula associated with diverticulitis of the sigmoid colon

◆要旨：患者は80歳，女性．持続する膿性帯下のため来院した．腹部造影CT検査で，S状結腸憩室炎に伴う結腸子宮瘻と診断され，腹腔鏡下S状結腸切除＋子宮合併切除を施行した．手術時間は4時間30分で出血量は50mlであった．術後合併症はなく，術後14日目で退院となった．S状結腸憩室炎に伴う結腸子宮瘻に対する手術として，腹腔鏡下手術は有用な術式の1つと考えられた．近年このような腹腔鏡下での拡大手術を行う機会も増えつつあり，われわれ外科医にとって，特に骨盤領域の腹腔鏡下手術をするうえで，婦人科および泌尿器科領域の解剖や手術手技を熟知することは大変重要であると考える．

An 80-year-old female with continuous purulent vaginal discharge visited our hospital. CT scan revealed colouterine fistula associated with diverticulitis of the sigmoid colon. She underwent laparoscopic sigmoidectomy combined with hysterectomy. The operating time was 270 minutes and blood loss was 50 ml. The postoperative hospital stay was 14 days without any postoperative complications. Laparoscopic surgery may be one of the useful operative procedures for colouterine fistula associated with diverticulitis of the sigmoid colon. In recent years, there has been a tendency of increased opportunity of carrying out laparoscopic extended surgery. Therefore, it is important to be familiar with gynecological and urological anatomies and their surgical techniques for laparoscopic pelvic surgery.