吊り上げ式腹腔鏡下胆囊摘出術を施行した小児胆囊結石症の2例

Two cases of cholecystolithiasis in children operated under gasless laparoscopic surgery

◆要旨：患者は4歳女児と7歳男児．腹痛を主訴に来院し精査を行ったところ腹部エコー検査で胆囊結石症を指摘された．整容性を考慮して単孔式内視鏡下手術を目指し，西井式吊り上げ鈎を用いた腹壁全層吊り上げ法で行った．臍部の皮膚をZ型に小切開を加え開腹後に2本の吊り上げ鈎にて腹壁を挙上した．右肋骨の挙上により横隔膜下のスペースが十分確保され，良好な術野が得られた．上腹部にポートを追加し2か所の創から手術を行った．鉗子はすべて細径鉗子を使用した．1例は術中胆道造影が可能であった．術後はいずれも良好に経過し，また整容性の保たれた手術となった．小児に対する胆囊結石症例に対して有用な方法の1つであると考えられた．

　A4-year-old girl and a 7-year-old boy were admitted to our hospital with complaints of abdominal pain. They were diagnosed as cholecystolithiasis by ultrasonography. Both operations were performed cosmetically under single port and gasless laparoscopic surgery in the style of Nishii. Z-shaped umbilical small incision was made, and abdominal wall was lifted using 2 lifting bars. Because right costal bone was lifted, right subdiaphragmatic space was expanded and large surgical field was obtained. One additional trocar was placed in the upper abdomen, and operation was performed under mini-laparoscopic surgery. Intraoperative cholangiography was performed in one case. Both patients had uncomplicated postoperative course and cosmetically-good incisional scar. We report these cases operated under gasless laparoscopic surgery, which was one of the useful methods in children.