大腿静脈圧迫症状をきたした巨大abdominoscrotal hydrocele（ASH）に腹腔鏡下囊胞切除を行った1例

Laparoscopic excision of a giant abdominoscrotal hydrocele（ASH）with femoral vein occlusion : a case report

◆要旨：Abdominoscrotal hydrocele（以下，ASH）は比較的稀であり，その病態，治療に関してはいまだに議論されている．今回筆者らは，静脈うっ滞による下腿腫脹を伴った巨大なASHに対して腹腔鏡下に囊胞切除を行った1例を経験したので報告する．患者は6か月，男児．右大腿静脈を圧迫する巨大なASHに対し，陰囊より穿刺排液後1か月で腹腔鏡下手術を施行した．手術は腹腔側より腹膜を切開し，可及的に囊腫壁を切除し開放した．ASHの治療はLPEC（laparoscopic percutaneous extraperitoneal closure）法では不十分であり，囊胞の切除やドレナージが必要と思われる．

　Abdominoscrotal hydrocele（ASH）is a comparatively rare condition, the etiology and treatment of which is still a matter of debate. We here report a case of laparoscopic excision of giant ASH with femoral edema owing to venous occlusion. A six month old boy was admitted to our hospital with a massive ASH that compressed the right femoral vein. Fluid was aspirated through the scrotum, and laparoscopic surgery was performed one month later. An incision was made in the peritoneum from the abdominal cavity, and as much as possible of the cyst wall was excised. Laparoscopic percutaneous extraperitoneal closure（LPEC）is not considered an effective method of treatment for ASH, and excision of the cyst wall and drainage is required.