ICG蛍光法を用いて腹腔鏡下肝囊胞天蓋切除術を施行した症候性巨大肝囊胞の1例

A case of symptomatic giant liver cyst treated by laparoscopic deroofing using intraoperative indocyanine green fluorescent cholangiography

◆要旨：症候性巨大肝囊胞に対する腹腔鏡下天蓋切除術は囊胞の再被胞化を避けるために十分な開窓が必要で，囊胞壁の広範囲切除が求められるが，切除範囲を広げすぎると囊胞壁内を走行する胆管を損傷するリスクが高まる．インドシアニングリーン（ICG）蛍光法を用いることにより，安全に手術しえた1例を報告する．患者は83歳，男性．右季肋部の膨隆と腹痛を主訴に来院した．有症状の単純性肝囊胞の診断となり，腹腔鏡下天蓋切除術を施行した．術中，切離線に出現した胆管をICG蛍光法で確認しクリッピングした．ICG蛍光法は簡便であり，胆管を正確に同定できることから，腹腔鏡下天蓋切除術において術後胆汁漏を予防する有用な手段と考えられた．

　Laparoscopic deroofing for symptomatic giant liver cysts requires sufficient fenestrations and wall resection to avoid cystic encapsulation. However, extended deroofing may result in damage of the bile ducts running in the cyst wall. We report a case of laparoscopic deroofing which was performed successfully using intraoperative indocyanine green fluorescent cholangiography. An 83 years old male patient was admitted to our hospital due to right abdominal distension. Abdominal computed tomography detected two huge hepatic cysts in the right hepatic lobe. Laparoscopic deroofing was performed. Bile ducts crossing on the cut line of the cyst wall were clearly detected by indocyanine green fluorescent cholangiography, and those bile ducts were securely clipped. Indocyanine green fluorescent cholangiography is a simple and useful technique to avoid biliary injury during laparoscopic deroofing of the liver cysts.