正中弓状靱帯圧迫症候群に対し，後腹膜アプローチによる靱帯切離術を施行した1例

Retroperitoneal endoscopic approach for the median arcuate ligament syndrome

◆要旨：患者は73歳，女性．腹部CTで偶発的に膵十二指腸動脈瘤を指摘され，精査・加療目的に当科紹介となった．腹部造影CTで正中弓状靱帯圧迫症候群に伴う腹部内臓動脈瘤の診断となり，準緊急的にコイル塞栓術が施行された．同時に施行した腹部血管造影検査や超音波ドップラー検査で腹腔動脈に逆行性血流を認め，血行力学的ストレスを有する症候例として，後腹膜アプローチによる正中弓状靱帯切離術が待機的に施行された．近年普及している腹腔鏡下アプローチでは，広い術野での精密な手術操作が困難となることもしばしば経験する．今回われわれは後腹膜アプローチを用いて良好な視野で安全に靱帯切離術を施行することができたため，文献的考察を含めて報告する．

　The patient was a 73 year-old woman. Abdominal enhanced computed tomography incidentally showed a 24 mm aneurysm in the anterior superior pancreaticoduodenal artery and the occlusion of the celiac artery origin. Transcathetel embolization was firstly performed, and angiography showed the retrograde flow in the common celiac artery. We diagnosed the patient as median arcuate ligament syndrome with hemodynamic stress and performed retroperitoneal endoscopic release. Postoperative course was uneventful, and abdominal ultrasound revealed the anterograde supply in the celiac artery. Although laparoscopic approach has been widely performed, it is sometimes quite difficult to reach the celiac axis and operate precisely. In this case, we could release the ligament securely with the wide view. We concluded retroperitoneal endoscopic approach could be considered as one option.