―囊胞性腹部疾患―肝囊胞性疾患に対する腹腔鏡下手術

Laparoscopic fenestration for nonparastic liver cysts

　要旨：内視鏡下手術の対象となる肝囊胞性疾患としては，巨大化した単純性肝囊胞と成人性多発性肝囊胞（adult polycystic liver disease：以下，APLD）が挙げられる．本稿では，それらの症状，あるいは機能障害軽減のための腹腔鏡下開窓術について詳述した．腹腔鏡下開窓術は，（1）術前診断（囊胞性状や周囲組織との解剖学的関係）の重要性，（2）部位による開腹下との難易度の相違点やピットフォールを把握して行えば，開窓術そのものは比較的容易な術式であり効果も高い．また，APLDの場合には，効果発現のために腎機能も重要である．良性疾患でもあり，危険性を考慮に入れて一期的根治にかかわることなく，低侵襲性の恩恵を生かすことが重要である．

　Laparoscopic fenestration（LF）has been performed on patients with simple large cysts and with adult polycystic liver disease（APLD）. In this report, we showed the essential preoperative studies, surgical method and its pitfall, and the outcome in LF. Intracystic fluid and cystic wall thickness, and the anatomical relation with the surrounding tissues and organs should be carefully evaluated preoperatively. Compared to fenestration under open laparotomy, some surgical procedures and identification of vascula-run may be difficult in some cases. Fenestration and the cauterization of cyst lumen basal surface tend to become inadequate in cysts located at S7 and S8 of the liver. Because LF is less-invasive and repeatable, it is not necessary to perform radical cure immediately. With these considerations, LF could be a useful method for patients with simple large cysts. For patients with APLD, the method would be useful when the patients'renal function is preserved.