LVAD装着患者の胆囊結石症に対して単孔式腹腔鏡下胆囊摘出術を施行した1例

A case of single incision laparoscopic cholecystectomy for heart failure patients with left ventricular assist device

◆要旨：症例は52歳，男性．特発性拡張型心筋症に対して約1年前に左心補助人工心臓（left ventricular assist device：以下，LVAD）を装着した．その後，急性胆囊炎を発症し保存的加療で軽快したが，胆石仙痛発作を繰り返すため，手術目的に当科を紹介受診した．術前精査の後，単孔式腹腔鏡下胆囊摘出術を施行した．術中・術後合併症は認めず術後7日目に退院した．LVAD装着患者に対する腹腔鏡下手術は，抗凝固療法による易出血性，ドライブラインの損傷や感染，気腹による血行動態の変動などに注意を要する．また，術後早期の抗凝固療法再開が必須であり，術後出血にも注意が必要である．LVAD装着患者に対し単孔式腹腔鏡下胆囊摘出術を施行したので報告する．

　A 52-year-old man underwent left ventricular assist device（LVAD）implantation about 1 year ago for idiopathic dilated cardiomyopathy. He subsequently developed acute cholecystitis, which resolved with conservative treatment, but he was referred to our department for surgery due to repeated attacks of cholelithiasis. Single incision laparoscopic cholecystectomy was performed, and he was discharged on postoperative day 7 with no intraoperative and postoperative complications. 　Laparoscopic surgery for patients with LVADs requires caution because of the ease of bleeding due to anticoagulation, driveline damage and infection, and hemodynamic changes due to insufflation. In addition, attention should also be paid to postoperative bleeding, as early resumption of anticoagulation therapy is necessary.