Duchenne型筋ジストロフィー症の成人男性に腹腔鏡下胆囊摘出術を行った1例

Laparoscopic cholecystectomy in an adult male with Duchenne muscular dystrophy

◆要旨：Duchenne型筋ジストロフィー症を伴った胆石性胆囊炎に腹腔鏡下胆囊摘出術を施行した1例を経験したので報告する．患者は36歳，男性．呼吸筋低下のため，術前よりnoninvasive positive pressure ventilationを施行しており，術後の呼吸器合併症が懸念された．麻酔に関しては，悪性高熱症を誘発する可能性があるため，吸入麻酔薬・筋弛緩薬は使用せず，プロポフォールとレミフェンタニルによる全静脈麻酔下に手術を行った．筋弛緩薬を使用していないため気腹による腹壁の挙上は乏しかったことと，側彎症のため低置肋骨弓であったことからworking spaceは狭く，腹腔内操作は困難であったが，腹腔鏡下手術を完遂できたことにより，開腹手術に比べて呼吸機能の悪化は軽度で，術後経過は良好であった．

Here we report the case of an adult patient with Duchenne muscular dystrophy, who underwent laparoscopic cholecystectomy for cholecystitis. A 36-year-old man with Duchenne muscular dystrophy had been treated with noninvasive positive pressure ventilation for severe weakness of the respiratory muscles. The patient was, therefore, particularly susceptible to severe respiratory complications after laparoscopic cholecystectomy. Surgery was performed under total intravenous anesthesia with propofol and remifentanil. Neither inhalational anesthetic nor muscle relaxant was used because of the high risk of malignant hyperthermia. The operative working space was restricted because of the poor elevation of the abdominal wall caused by the absence of muscle relaxant and the low-lying costal arch caused by scoliosis. However, laparoscopic cholecystectomy was less invasive than laparotomy and deterioration of pulmonary function was minimal, contributing to the smooth postoperative course.