高度亀背例に対してポート位置の工夫にて腹腔鏡下胆囊摘出術を施行しえた1例

A case of laparoscopic cholecystectomy for gallbladder stones in patients with severe kyphosis achieved by developing a new approach

◆要旨：患者は79歳，女性．高ビリルビン血症の精査のために当院を受診した．胆囊結石，総胆管結石，胆管炎と診断され，内視鏡的乳頭切開および砕石術を行った後に腹腔鏡下胆囊摘出術（以下，LC）が予定された．全身麻酔下に筋弛緩薬を投与した後も約90度の亀背状態で，肋骨弓―恥骨間が極端に狭く，通常のポートの配置でのLCは困難であった．そこで体内と体外のworking spaceを確保するために，肋間からポートおよびMiniLap^TM（Stryker）を挿入し，LCを完遂した．患者が強い亀背を有する場合，フリーの腹壁が狭く，体内および体外のworking spaceの確保が困難となる．今回ポートの位置を腹部にこだわらず，肋間に挿入することで安全にLCを行うことができたので報告する．

The patient was a 79 year-old woman who had gallbladder stones and common bile duct stones. She had undergone endoscopic sphincterotomy and choledocolithotomy and was referred to our division for laparoscopic cholecystectomy. She had severe kyphosis with a kyphotic angle of almost 90 degrees and it was not possible to place the trocars at usual the positions. Therefore, we placed the MiniLap^TM and the trocar for the endoscope at the lower intercostal spaces. Using this procedure, we achieved good endoscopic vision for the surgery and could perform it easily. Placing several trocars at the lower intercostal spaces provides good working space during laparoscopic cholecystectomy for patients with severe kyphosis.