腹腔鏡下に切除した脾動脈瘤の1例—手術の工夫について

A case of splenic artery aneurysm resected laproscopically

◆要旨：患者は51歳，男性．肺癌検診のCTで脾門部に50mmの脾動脈瘤を指摘された．脾摘出を伴う脾動脈瘤切除術を予定した．動脈瘤破裂に備え，膵脾の授動前に脾動脈の分枝を先行切離し，膵体部で脾動脈をいったん確保した後に膵尾部で脾動脈を切離する方針とした．4ポートで手術を行った．左胃大網動脈，短胃動脈，後胃動脈を切離後，予定通り脾動脈を確保し，切離した．膵尾部と脾動脈瘤の剝離と脾の授動後に脾静脈を切離し，切除しえた．腹腔鏡下に切除した本邦で最大の脾動脈瘤であった．脾動脈確保部は術前画像検査で予測可能であった．動脈瘤破裂の予防と破裂時の出血を抑える術式の工夫で，脾動脈瘤は腹腔鏡下に安全に切除できると考えられた．

　We report a case of splenic artery aneurysm which was treated laparoscopically. A 51 year-old male patient was diagnosed with a splenic artery aneurysm at the splenic hilum by computed tomography（CT） for lung cancer screening. The aneurysm measured 50mm in diameter. Preoperative angiography estimated 40％ splenic infarction by embolization of the aneurysm; thus, resection of the aneurysm accompanied by splenectomy was scheduled. To prevent rupture of the aneurysm, we planned to resect the left gastroepiploic artery, short gastric arteries and posterior gastric artery firstly, then the splenic artery prior to mobilization of the spleen. Based on the CT findings, we planned to dissect the splenic artery at the pancreas body firstly, and then, close to the aneurysm. The operation was performed with 4 trocars. The operation was completed by resecting the splenic vein. This is the biggest splenic artery aneurysm resected laparoscopically in Japan. Laparoscopic resection of splenic artery aneurysms can be performed safely by devascularizing aneurysmal inflow prior to mobilization of the spleen.