左上腰ヘルニアに対して単孔式腹腔鏡下に完全腹膜外修復を行った1例

A case of superior lumbar hernia successfully treated by single-incision laparoscopic surgery for totally extraperitoneal repair

◆要旨：患者は86歳，女性．約1週間前から左腰背部の膨隆と疼痛を自覚して当院を受診した．初診時には同部位に5cmの膨隆を認め，用手還納は容易であった．腹部単純CTにて左側背腹部に脂肪組織の脱出を認め，また腹部MRIでは腹腔内脂肪と後腹膜脂肪の脱出を認めた．左上腰ヘルニアと診断し，単孔式腹腔鏡下に腹膜前到達法（totally extraperitoneal approach：TEP）で修復を施行した．手術時間は112分，出血量は1gで，術後経過は良好であり再発も認めていない．本邦では上腰ヘルニアに対してTEPを施行した症例は少なく，かつ単孔式腹腔鏡下腹膜外修復法（single-incision laparoscopic surgery for totally extraperitoneal repair：SILS-TEP）にて行った症例は報告上では本邦初である．今回，本疾患に対してSILS-TEPは有用であったと考えられたため，文献的考察を加えて報告する．

　An 86-year-old woman was admitted for a bulge and pain of a left dorsal lumbar region. At the initial physical examination, we found a 5-cm reducible swelling at the same region. Abdominal computed tomography showed prolapse of a fat tissue from a hernia orifice in the left dorsal lumbar region, and abdominal MRI also showed prolapse of an intraperitoneal fat tissue and a retroperitoneal fat tissue in the same region. She was diagnosed as left superior lumber hernia, and underwent single-incision laparoscopic surgery for totally extraperitoneal reapir. During the surgery, we confirmed the 3.5-cm hernia orifice at the superior lumbar triangle. The hernia orifice was covered with a trimmed ProGrip^TM mesh, 12-cm in diameter. The operative time and estimated blood loss were 112 min and 1 g, respectively. The patient was discharged uneventfully on the second postoperative day. There were no signs of recurrence for 6 months after the operation. We herein report that single-incision laparoscopic surgery for totally extraperitoneal repair was considered to be a useful treatment for managing superior lumbar hernia, and review the relevant literature.