馬蹄鉄腎に合併した腎盂尿管移行部狭窄症に対する腹腔鏡下腎盂形成術

A case report of laparoscopic pyeloplasty for ureteropelvic junction obstruction in a patient with horseshoe kidney

◆要旨：患者は28歳，女性．左背部痛を主訴に近医を受診し，左水腎症を指摘された．精査目的に当科を紹介され，腹部CT検査にて馬蹄鉄腎とそれに伴う左腎盂尿管移行部狭窄症と診断した．約4か月間で左背部痛が数回出現し，治療を希望したため腹腔鏡下手術を施行した．術中所見では交差血管は認めなかったが，尿管高位付着による狭窄が考えられ，尿管と腎盂に強い癒着がみられた.癒着剝離後にAnderson-Hynes法による腎盂形成を施行したが，峡部離断術は行わなかった．術後経過は良好で超音波検査にて水腎症は改善し，左背部痛も現在までみられていない．今回の経験から腹腔鏡下腎盂形成術は馬蹄鉄腎例でも有用であると思われた．

A 28-year-old female who complained of left flank pain was referred to our institution to be investigated about left hydronephrosis. She was diagnosed as horseshoe kidney with ureteropelvic junction obstruction by computed tomography（CT）. She has suffered from left colic flank pain for about 4 months. She underwent laparoscopic dismembered pyeloplasty without additional division of the isthmus because the obstruction was thought to be due to high insertion of ureter, and not to pressure where the ureter crossed the kidney. The operation time was 157minutes with minimal blood loss. The patient was discharged without any complications, and has not complained of pain during follow-up term. We considered that laparoscopic pyeloplasty could be feasible and safe for uretero-pelvic junction obstruction associated with horseshoe kidney.