肝内結石症に対して施行した腹腔鏡下肝左葉切除術

Laparoscopic left hepatectomy for intrahepatic cholelithiasis

◆要旨：腹腔鏡下手術の急速な発展は肝臓外科の領域にも拡がり，いくつかの施設から腹腔鏡下肝葉切除の報告も行われるようになってきた．しかし，出血やCO₂塞栓の問題があり，部分切除と外側区域切除を除いては完全腹腔鏡下手術の報告はほとんどないのが現状である．患者は60歳の男性で，右上腹部痛と発熱を主訴に来院した．検査で肝内結石症と判明し，完全腹腔鏡下に肝左葉切除術を施行した．肝門処理・肝授動・浅層での肝実質切離には超音波凝固切開装置が，深部の肝実質切離には超音波メスが有用であった．術後経過は良好で第2病日目に経口摂取を開始し，第8病日目に退院した．完全腹腔鏡下肝左葉切除は肝切除の有用な術式になると思われた．

　Laparoscopic surgery for hepatic diseases has been gaining acceptance recently. Several reports of hepatic lobectomy have appeared in the literature. However, totally laparoscopic hepatectomy is still confined to either partial one or lateral segmentectomy since there are not enough data to indicate whether this procedure can be safely performed without the fear of massive bleeding or CO₂-embolism．A 60-year-old male was admitted to our hospital for right upper abdominal pain and fever．ERCP revealed intrahepatic cholelithiasis．Totally laparoscopic left hepatic lobectomy was planned．Two surgical devices were introduced into the procedure : ultrasonic surgical aspirator for dividing the liver in deep layer and ultrasonic coagulation shears for hilar dissection, liver mobilization and parenchymal division in superficial layer．The operation was performed securely without any complication．The patient showed rapid postoperative recovery．Oral intake was started on 2 postoperative day（POD）and he was discharged on 8 POD．Totally laparoscopic left hepatic lobectomy should become a reasonable alternative for patients with resectable liver disease．However, further technical improvements are required in liver parenchymal division for patients with liver cirrhosis．