膨潤麻酔併用の腹腔鏡下鼠径ヘルニア修復術（TEP法）を施行した成人Nuck管水腫の1例

A case of adult Nuck's hydrocele treated by laparoscopic inguinal hernia repair（TEP） with tumescent local anesthesia

◆要旨：症例は34歳，女性．約1か月前から右鼠径部膨隆を自覚し当院を受診した．右鼠腹部CT検査では右鼠径管内に30×15mm大の囊胞性腫瘤を認め，Nuck管水腫と診断し手術の方針となった．手術は膨潤麻酔法を併用した腹腔鏡下鼠径ヘルニア修復術（TEP法）を施行した．囊胞性腫瘤を鼠径管から剝離し，子宮円靱帯とともに囊胞性腫瘤を切除して臍部の創より摘出した．鼠径床をメッシュで補強し手術を終了した．Nuck管水腫は子宮内膜症や悪性腫瘍の合併例の報告があり水腫の完全切除が望ましい．膨潤法を併用したTEP法は腫瘤が確認しやすくなり，鼠径管内の剝離も容易で，本症の治療に有用であると考えられた．

　A 34-year-old woman was admitted to our hospital with a complaint of swelling of the right inguinal lesion. Abdominal computed tomography（CT） revealed a cystic mass（30×15mm） in the right inguinal canal and the lesion was diagnosed as a Nuck's hydrocele. We performed totally extraperitoneal preperitoneal repair（TEP） with tumescent local anesthesia, and the mass was completely resected with the round ligament. Nuck's hydrocele is often complicated with endometriosis and cancer, therefore, complete resection of the mass is necessary. TEP with tumescent local anesthesia is very useful because the mass and the round ligament are easily recognized and detached. We report our experience with a review of the literature.