腹腔鏡下に修復しえた後腹膜的腎摘除術後の上腰ヘルニアの1例

A case of superior lumber hernia following left nephrectomy treated with laparoscopic tension-free repair

◆要旨：症例は49歳，女性．左腎癌に対して後腹膜的到達法にて根治的腎摘除術を受け，その後，左腰背部に増大傾向のある膨隆が出現したため当院受診した，腹部造影CT検査で左上腰三角において第12肋骨先端が欠損し，第11肋骨下，腰方形筋外側，腹横筋・外内腹斜筋内側の腹壁筋層の欠損を認めた．ヘルニア門径は10×6 cm長であり，下行結腸・小腸を内容物とする左腎摘除術後上腰ヘルニアと診断した．手術は腹腔鏡下に下行結腸と脾臓を授動し，Ventralight ST^®を用いてintraperitoneal onlay mesh法で修復した．術後6か月の現在，再発を認めていない．根治的腎摘除術後に発生した腰ヘルニアに対する腹腔鏡下修復術は有用であるが，本邦での報告は3例と少なく，今後の症例の蓄積が期待される．

　The patient was a 49-year-old woman who underwent left nephrectomy for renal cancer 6 years earlier. She visited our hospital after noticing a bulge on her back left posterior side. Abdominal computed tomography revealed a left lumbar hernia involving the descending colon and the small intestine, so we performed laparoscopic total intraperitoneal hernia repair. Intraoperatively, a 10×6-cm defect was found and the hernia orifice repair was performed by intraperitoneal onlay mesh（IPOM）method using Ventralight ST^®. No relapse has been observed for 6 months after the operation. For superior lumber hernias occurring after nephrectomy, laparoscopic repair may be a safe and effective intervention than conventional front approach. There are few reports on the laparoscopic tension-free repair for lumber hernia after nephrectomy, and further reports would be expected.