門脈圧亢進症による人工肛門静脈瘤に対して腹腔鏡下脾臓摘出術および下腸間膜静脈遮断術を施行した1例

A case of stromal varices treated with laparoscopic splenectomy and inferior mesenteric vein ligation

◆要旨：患者は67歳，男性．直腸癌に対する直腸切断術および人工肛門造設術の6年後，C型肝硬変に伴う門脈圧亢進症により下腸間膜静脈を供血路とした人工肛門静脈瘤および出血を認めた．2年後に食道静脈瘤の発達および出血を認め，内視鏡的静脈瘤結紮術を施行した．消化器内視鏡的治療を進めることで，門脈圧の上昇により人工肛門静脈瘤への供血が悪化し，再出血が危惧された．門脈圧の減圧を目的として腹腔鏡下脾臓摘出術，供血路の血行遮断として下腸間膜静脈遮断術を施行した．術後に人工肛門静脈瘤の血栓化および退縮を認めた．全身状態が安定した症例では，人工肛門静脈瘤に対して腹腔鏡下手術も有効な治療選択肢となると考えられた．

　The patient was a 67-year-old male. He underwent rectal amputation and a colostomy for rectal cancer. Six years after the operation, stomal varices supplied by inferior mesenteric vein due to portal hypertension associated with type C liver cirrhosis and bleeding were found. Two years later, the development of bleeding esophageal varices was discovered and endoscopic variceal ligation was performed. Continuing the treatment for esophageal varices would have increased the risk of rebleeding from the stomal varices due to worsening portal hypertension. Therefore, a laparoscopic splenectomy was performed to reduce the portal vein pressure, and inferior mesenteric vein ligation was performed to block the blood supply to the stomal varices. The postoperative course was good, and both regression and thrombosis of the stomal varices were observed. Laparoscopic operation for stomal varices is an effective therapeutic option if the patient's general condition is stable.