正中弓状靱帯圧迫症候群に対して腹腔鏡下超音波を併用し正中弓状靱帯切離術を施行した1例

A case of median arcuate ligament resection with laparoscopic ultrasound for the stenosis of the celiac artery caused by median arcuate ligament compression

◆要旨：患者は60歳，女性．心窩部痛を自覚し近医を受診し，造影CT検査で十二指腸水平脚に接する50mm大の低吸収域を認めたため当院へ紹介となった．正中弓状靱帯圧迫症候群に伴う下膵十二指腸動脈瘤破裂による血腫と診断し，緊急で選択的動脈塞栓術を施行した．3か月後に患者の同意のもと，膵十二指腸動脈領域の代償的血流増加解除目的に，腹腔鏡下正中弓状靱帯切離術を施行した．腹腔鏡下超音波を併用し，良視野のもと総肝動脈や脾動脈など主要血管を剝離露出せずに確実な正中弓状靱帯切離が可能であった．フォローアップCT検査では，腹腔動脈起始部の狭窄所見は残存なく動脈瘤再発もなく経過している．

　The patient was a 60-year old woman. She had epigastric pain and went to the hospital. Contrast CT examination showed a 50mm hematoma contacting the third part of the duodenum, and an aneurysm in the inferior pancreaticoduodenal artery was found in the hematoma. Additionally, stenosis of the celiac artery origin due to median arcuate ligament compression was observed （median arcuate ligament syndrome : MALS）. We diagnosed hematoma by rupture of the aneurysm in the inferior pancreaticoduodenal artery and performed urgent angiogram and selective arterial embolization. After obtaining the patient's consent, laparoscopic median arcuate ligament resection was performed to release pressure on the pancreatoduodenal artery arcade. Laparoscopic surgery combined with intraoperative ultrasonography ensured median arcuate ligament resection without exposing major vessel such as the common hepatic and splenic artery in a good operative field. On follow-up CT examination, stenosis of the celiac artery origin and aneurysm has not recurred.