閉鎖孔ヘルニア嵌頓症例に対する緊急腹腔鏡下手術の検討

Investigation of emergency laparoscopic surgery for incarcerated obturator hernia

◆要旨：閉鎖孔ヘルニア嵌頓に対して緊急腹腔鏡下手術を行った20例の手術成績から本術式の有用性について検討した．腸管切除例9例を含む全例が腹腔鏡下で完遂可能であった．術中に対側の閉鎖孔ヘルニアを56.3％と高率に認め，さらに他のヘルニア合併を75.0％に認めた．骨盤腔内精査における腹腔鏡の優越性が，これらの病変を視認可能にしたと考えられた．ヘルニア門の修復法は，再発や異時性ヘルニアを考慮して，閉鎖孔と筋恥骨孔の両方を覆うことができるTAPP法を選択し，汚染症例に対しては二期的根治術を行った．潜在病変を確認し，同時に予防的根治術を行うことができる腹腔鏡下手術は，閉鎖孔ヘルニア嵌頓症例に対する有用な術式と考えられた．

We investigated the emergency laparoscopic surgical results of 20 cases with incarcerated obturator hernia（OH） and assessed the effectiveness of this operative procedure. All cases including nine cases with intestinal resection were able to be accomplished by laparoscopic surgery（LS）. During endoscopic operation, bilateral OH was found in 9 out of 16 patients（56.3％）. In addition, other hernias were observed in 12 out of 16 patients（75.0％）. These lesions could be visually recognized by the superiority of LS in scrutiny of the pelvic cavity. Considering recurrent and metachronous hernias, we chose TAPP for OH repair to cover both entire obturator foramen and myopectineal orifice, and a two-stage hernia repair was performed for contaminated cases. As described above, LS allows detection of potential lesions. Furthermore, preventive radical operation for them can be completed by LS simultaneously. Therefore, we believe that LS for incarcerated OH is useful operative procedure.