腹腔鏡下切除術を施行した未破裂腸間膜動脈瘤の1例

A case of an unruptured mesenteric artery aneurysm resected via laparoscopic surgery

◆要旨：症例は71歳，男性．S状結腸憩室出血にて当院受診し，血管造影にて空腸動脈第二枝と回結腸動脈にそれぞれ6mm，5mm大の動脈瘤を認めた．血管内治療は困難であり，腹腔鏡下切除の方針となった．動脈瘤の同定方法が問題となるが，中枢側から末梢へ向かって血管を剝離して，動脈瘤を同定した．辺縁動脈の分岐部のため動脈瘤へは3本の流入血管をすべてクリップし切除し，安全に手術を終了することができた．血行再建を必要としない腸間膜に発生した動脈瘤に対して腹腔鏡手術は有用であることが示唆されたため，文献的考察を加えて報告する．

　The patient was a 71-year-old man with diverticular bleeding in the sigmoid colon. Angiography revealed aneurysms, measuring 6 mm and 5 mm, in the second branch of the jejunal artery and the ileocolic artery, respectively. Interventional radiology treatment was difficult, so laparoscopic resection was performed. Identifying aneurysms can be problematic. However, the aneurysm was identified by detaching the blood vessel from the central side to the periphery. All three inflowing arteries were clipped, and the aneurysm was resected. Consequently, the operation was safely performed. Laparoscopic surgery was useful for mesenteric aneurysms that did not require revascularization.