ロボット支援腹腔鏡下直腸低位前方切除術に伴う8mmポートにヘルニア嵌頓を発症した1例

A case of 8 mm port site hernia after robot-assisted laparoscopic low anterior resection

◆要旨：症例は73歳，女性．孤立性肺転移・肝転移を伴う上部直腸癌に対し，術前化学療法の後，原発巣切除目的にロボット支援腹腔鏡下直腸低位前方切除術（D3）を施行した．術後経過は良好で，右下腹部8mmポート創を挿入孔としたドレーンを術後第7病日に抜去したが，その翌日に腹部膨満と嘔吐を認めた．精査にてドレーンを抜去した右下腹部8mmポート創への小腸のヘルニア嵌頓を認め，同日緊急手術となった．腹腔鏡下に手術を行ったが，手術所見も同様の所見であり，用手的還納後に同ポート創は全層結節縫合にて縫合閉鎖した．文献上，8 mmポートへのヘルニアの発生頻度自体は低いが，ドレーン挿入孔として使用した際は注意が必要である．

　The patient was a 73-year-old woman. After preoperative chemotherapy for upper rectal cancer with solitary lung and liver metastases, robot-assisted laparoscopic low anterior rectal resection（D3）was performed to remove the primary tumor. The postoperative course was uneventful, and the drainage tube inserted from robotic 8 mm port wound in the lower right abdomen was removed on the 7th postoperative day. However, vomiting and abdominal distention were observed the next day. Abdominal computed tomography（CT）revealed an incarcerated small bowel hernia in the 8 mm port wound in the lower right abdomen where the drain had been removed. Emergency operation was performed on the same day. The laparoscopic findings matched the radiographic findings, and the port site was sutured with all layers after manual hernia reduction. According to the literature, the frequency of hernia occuring at 8mm port itself is low, but caution is required when using it as a drain insertion hole.