腹腔鏡下手術が有用であった腹腔交通型の水腫を認めるNuck管水腫の1例

Abdominoscrotal hydrocele identified in a case of hydrocele of the canal of Nuck, effectively treated by laparoscopic surgery

◆要旨：患者は46歳，女性．鼠径部腫脹と圧痛を主訴に近医を受診し，鼠径ヘルニア嵌頓と診断され当院紹介となった．当院受診時に造影CTで造影不良域を認め，用手整復困難であったため，緊急手術の適応と判断した．腹腔鏡の所見で，明らかな嵌頓腸管や付属器はなく，子宮円靱帯に水腫を認め，Nuck管水腫と診断した．治療は腹腔鏡下に子宮円靱帯を恥骨付着部から腹腔内の水腫の遺残がないところで切離摘出し，transabdominal preperitoneal approach（TAPP）同様の手技でメッシュを留置し手術を終了した．Nuck管水腫は鼠径管内のみでなく腹腔内の子宮円靱帯にも存在することがあり，水腫を完全に摘出するには腹腔鏡下手術は有用な選択肢の1つになると考えられた．

　A 46-year-old female consulted a local doctor because of left inguinal swelling and tenderness. She was diagnosed with incarcerated inguinal hernia and was referred to our hospital. As we were unable to apply manual repositioning, we conducted an emergency operation by laparoscopic surgery. Laparoscopic examination showed that neither the patient's intestines nor her adnexa were strangulated; however, the patient's round ligament was found to contain hydrocele. Thus, our diagnosis was hydrocele of the canal of Nuck. By laparoscopic surgery, we extirpated the round ligament with hydrocele and placed a mesh in the peritoneal cavity with the same approach as in transabdominal preperitoneal approach（TAPP）. Therefore, in noting that hydrocele can be present not only in the inguinal canal but also within the abdominal portion of the round ligament, we consider laparoscopic surgery to be effective for removing hydrocele in entirety.