腹壁吊り上げ法による腹腔鏡補助下脾摘術

Laparoscope assisted splenectomy by abdominal wall lifting method.

　腹腔鏡下脾摘術をより安全かつ簡便に行うためLaparolift system^TMと小開腹を併用した腹腔鏡補助下脾摘術を考案した．本法を用いて特発性血症板減少性紫斑病の女性患者と遺伝性球状赤血球症の男性患者に対し脾摘術を行ったが，いずれも比較的短時間内に少量の出血で手術を終了し，術後経過は良好であった．小開腹創を通して開腹手術時に用いる鉗子を使用し血管剥離などを行うので血管処理が容易かつ確実に行え，また巨脾の症例に対しても安全に行えることが判明した．本法は良好な視野のもと安全確実な手術操作が可能であり，たとえ内視鏡外科手術に熟達していなくても安心して行える低侵襲な術式と考えられた．

A technique of laparoscope assisted splenectomy with combination of Laparolift system and mini-laparotomy was developed. This procedure was performed on one female patient with idiopathic thrombocytopenic pur-pura and one male patient with hereditary sphero-cytosis and was completed successfully within satisfac-tory operating time and blood loss. It is possible for surgeon to ligate and divide the splenic hilar major vessels safely and certainly with the conventional instruments used in open surgery. This procedure was certified to be feasible also in patient with splenomegaly.