手術既往のないイレウスに対する腹腔鏡下手術―腹腔鏡下手術にて診断・治療しえた内ヘルニアの5例―

Laparoscopic surgery of five patients with internal hernia

開腹既往のないイレウス，特に内ヘルニア症例に対して腹腔鏡下手術を施行した5症例のうち3例を呈示するとともに，腹腔鏡アプローチの有用性について検討した．術前，原因診断不明例は大網裂孔ヘルニアの2例，疑診例は子宮広間膜裂孔ヘルニアの1例であったが，腹腔鏡を挿入し確定診断を得るとともに，腹腔鏡操作のみで嵌頓を整復しえた．術前画像にて確定診断を得たものは閉鎖孔ヘルニアの2症例であった．腹腔鏡下手術を行い嵌頓腸管の整復を行ったが，すでに腸管の壊死・穿孔が存在していたため小開腹を置き腸切除を施行した．腹腔鏡アプローチは内ヘルニアの診断および治療方針の決定に優れ，さらに低侵襲性の観点からも有用であると思われた．

　We report five internal hernia patients without any history of previous surgery who underwent laparoscopic surgery. Usefulness of this surgical method is also reported. In two patients, diagnosis of transomental hernia was obtained by laparoscopy, and they were treated by laparoscopic surgery. In one patient, the diagnosis of internal hernia of the broad ligament of the uterus was suspected. The diagnosis was confirmed and the patient was treated by laparoscopic procedure. Postoperative recovery of these patients was uneventful and fast. Laparoscopic surgery was performed in two patients with obturator hernia. In these two patients, however, the procedure was converted to open surgery due to necrotic perforation of the incarcerated small intestine. On review of our five patients, we conclude that laparoscopic approach is useful for the diagnosis and treatment of internal hernia.