尿膜管遺残症に対する小児期の腹腔鏡下尿膜管摘出術—当科における工夫と術式の要点について

Laparoscopic surgery for urachal remnant in childhood : Our surgical devices and the goals of the operation

◆要旨：【目的】尿膜管遺残症に対する腹腔鏡下尿膜管摘出術（本術式）の手技の詳細は施設間にて相違がある．今回当科の工夫を報告する．【対象】過去4年間で本術式を施行した7症例を対象とする（中央値11歳，男女比4：3）．【術式】まず臍輪をローンスターリトラクターシステムで展開し，臍輪内にて瘻孔を最小の径で全周性にくり貫いた後，瘻孔端を腹腔内に落とし込む．膀胱まで剝離後，尿膜管を切離し，最後に剝離した腹膜もLPEC針で縫縮する．【結果】手術時間の中央値150分，術後在院日数は中央値4日であった．現在まで合併症や再発は認めていない．【結論】本術式は少しの工夫によりさらにスムーズな操作性を得ることができる．

【Objective】 In different hospitals, various techniques are applied in laparoscopic surgery for the treatment of urachal remnant. We herein report our surgical techniques and the devices that we use in performing laparoscopic surgery for urachal remnant. 【Patients】 In the last 4 years, a total of 7 patients（male, n＝4; female, n＝3） with urachal remnant were treated by laparoscopic surgery. The median patient age was 11 years. 【Operation】 The umbilical ring is unfolded using the Lone Star Retractor System^TM and the umbilical urachal sinus in the bottom part of the umbilicus is hollowed out like a circle. The end of the urachal sinus is inserted into the abdomen space and the urachal remnant is resected from the peritoneum by laparoscopic surgery. The removal of the urachal remnant is completed and finally the resected peritoneum is repaired using an LPEC needle. 【Results】 The median operative time was 150 minutes. The median hospital stay after surgery was 4 days. We did not experience any cases involving postoperative complications or recurrence. 【Conclusion】 These surgical techniques, which use small devices, facilitate a smooth operation in laparoscopic surgery for urachal remnant.