小児腹部救急領域における臍部ジグザグ切開を併用した単孔式腹腔鏡補助下手術の有用性

The usefulness of single incision laparoscopic surgery with umbilical zig-zag incision in emergency pediatric abdominal cases

◆要旨：小児腹部救急領域における腹腔鏡下手術の適応が拡大しているなか，外科医の技術の進歩や手術器具の開発とともに単孔式腹腔鏡下手術を導入する施設も増加している．一方で，小児症例特有の問題点も指摘され，腹腔鏡下手術の適応は慎重に症例を選択する必要がある．今回筆者らは，9歳から15歳までの外傷性腹腔内出血，外傷性小腸穿孔，大腸憩室穿孔の3例に対して，単孔式腹腔鏡補助下手術を施行した．臍のジグザグ切開と単孔式腹腔鏡下手術用アクセスポートを組み合わせることで，開腹手術と同等な手技と安全性を確保するとともに，整容面でも良好な手術が行えたため，その有用性を報告する．

　In recent years, the adaptation of laparoscopic surgery in the area of emergency pediatric abdominal surgery has been expanding. With the development of surgical instruments and technological advances made by the surgeon, facilities introducing single incision laparoscopic surgery for emergency treatment of pediatric abdominal disease have increased. However, specific problems related to pediatric cases have also been pointed out, and a safer procedure is required. By combining the use of a single incision laparoscopic access port with the zig-zag incision, we have performed surgery with combined safety and security equal to that of open laparotomy and with excellent cosmesis equal to that of multi-port laparoscopic surgery. We have applied this procedure in three cases of emergency surgery in 9- to 15- year old patients to treat traumatic hemoperitoneum, traumatic small bowel perforation, and perforation of a colonic diverticulum. We report here the usefulness of the procedure.