巨大肝囊胞に対する腹腔鏡下天蓋切除術においてindocyanine green蛍光法が胆管交通部の同定に有用であった1例

A case of a giant hepatic cyst with biliary communication successfully treated with laparoscopic deroofing using intraoperative indocyanine green fluorescent cholangiography to identify the site of bile leakage into the cyst

◆要旨：近年，indocyanine green（ICG）蛍光法を用いた術中胆道造影法の有用性が報告されている．今回，胆管との交通を有する巨大肝囊胞に対する腹腔鏡下天蓋切除術（laparoscopic deroofing：LD）においてICG蛍光法を用いることで，囊胞内への胆管交通部の同定が容易となり，腹腔鏡下に縫合閉鎖できた1例を経験したため報告する．症例は75歳，女性．下腿浮腫の増悪を主訴に当院を受診した．造影CT検査にて15cm大の巨大肝囊胞により下大静脈の圧排・狭小化を認め，下大静脈圧排に伴う下腿浮腫と診断し，LDを施行した．天蓋切除後に囊胞内に胆汁貯留を認め，ICG蛍光法を用いて蛍光胆汁が囊胞内へ漏出する部位を確認し，腹腔鏡下に縫合閉鎖した．術後胆汁漏は認めず，第6病日に退院となった．

　Recently, the usefulness of intraoperative indocyanine green（ICG） fluorescent cholangiography has been reported. In this report, we describe a case of laparoscopic deroofing（LD） of a giant hepatic cyst with biliary communication, in which the use of intraoperative ICG fluorescent cholangiography facilitated identification of bile leakage within the cyst and suture closure was achieved under laparoscopy. The patient was a 75-year-old woman. She came to our hospital with a chief complaint of worsening leg edema. Contrast-enhanced CT scan revealed compression and narrowing of the inferior vena cava due to giant hepatic cysts with a maximum diameter of 15 cm, and LD was performed. During the operation, ICG fluorescent cholangiography was used to detect the site of bile leakage into the cyst, and the site of leakage was sutured closed under laparoscopy. There was no postoperative bile leakage, and the patient was discharged on the 6th postoperative day.