単孔式胃内手術・腹腔鏡手術により摘出した胃と十二指腸巨大毛髪結石の1例

Double trichobezoar in the stomach and duodenum treated by single incision intragastric and laparoscopic surgery

◆要旨：患者は14歳，女児．胃・十二指腸内毛髪結石に対し，整容性の高い手術を希望して来院した．術前検査にて，巨大な毛髪胃石の他，るい痩とSMA（superior mesenteric artery）症候群を併発し，十二指腸の拡張を認めた．当症例に対し，Xゲート^®を使用した胃内手術にて毛髪胃石を摘出し，十二指腸毛髪結石に対しては単孔式腹腔鏡手術に2mm鉗子を追加して摘出した．併発している閉塞性十二指腸炎の状況を鑑み，十二指腸縫合閉鎖部には大網を被覆し，術後薬剤による膵外分泌抑制を併用した．患者は合併症なく術後9日目に退院した．胃および十二指腸の毛髪結石に対し，自験例のように単孔式＋2mm鉗子による内視鏡下手術を行った症例は初めての報告と思われる．

　A 14 year-old female, who was found to have a giant trichobezoar in her stomach, was referred to us, seeking a less invasive surgical treatment. Besides the giant trichobezoar in the stomach, another big bezoar was found in the distal duodenum, and superior mesenteric artery syndrome with a remarkably dilated proximal duodenum was recognized. Surgical procedure included two parts, 1）single incision intragastric surgery to extract the trichobezoar in the stomach, 2）single incision surgery with 2mm assistant forceps to extract the duodenal trichobezoar. No significant complications were encountered intraoperatively. Pancreatic exocrine inhibitor was administrated postoperatively. The patient was discharged on post operative day 9. The current report seems to be the first case with gastric and duodenal trichobezoar treated by single incision laparoscopic surgery.