成人Nuck管水腫に対し腹腔鏡下と鼠径部切開のHybrid手術を施行した1例

A case of hybrid laparoscopic and inguinal incisional surgery for adult hydrocele of the canal of Nuck

◆要旨：症例は33歳，女性．不正性器出血と左鼠径部膨隆，慢性骨盤痛，過多月経を主訴に受診した．単純CT検査で左鼠径部皮下から腹壁に囊胞性腫瘤を認め，Nuck管水腫が疑われた．腹腔鏡下で内鼠径輪近傍に囊腫を確認した．また，骨盤内腹膜に黒色斑点があり子宮内膜症が疑われた．内鼠径輪の腹膜切開を行い子宮円靱帯に付着する囊腫を確認し，子宮円靱帯を切離した．続いて鼠径部から鼠径管を開放，子宮円靱帯を恥骨側まで剝離して囊腫を完全切除した．Transabdominal preperitoneal approach（TAPP）法で腹壁補強を付加し終了した．病理組織検査で子宮内膜症と診断された．成人のNuck管水腫は子宮内膜症や腺癌の合併報告があり，完全切除が望ましい．腹腔内から鼠径管に続くNuck管水腫に対し，Hybrid手術は有用であると考えられた．

　A 33-year-old woman consulted our department because of abnormal genital bleeding and left inguinal swelling and pain. A plain computed tomography scan showed a cystic mass in the left inguinal subcutaneous region and abdominal wall, and a hydrocele of the canal of Nuck was suspected. Laparoscopic observation revealed a cyst under the peritoneum near the inner inguinal ring. In addition, black spots were scattered on the pelvic peritoneum, and endometriosis was suspected. A peritoneal incision of the internal inguinal ring revealed a cyst attached to the uterine circumflex ligament. The cyst was removed without leaving any residual cyst tissue. The inguinal canal was then opened through an incision in the inguinal region, revealing a cyst. The uterine round ligament was dissected toward the pubic side, and the cyst was completely resected. Finally, transabdominal pre-peritoneal repair was performed to reinforce the abdominal wall. Histopathological examination revealed ectopic endometriosis. Complete resection is desirable in adult patients with a hydrocele of the canal of Nuck because ectopic endometriosis and adenocarcinoma have been reported as complications of such hydroceles. Hybrid surgery for a hydrocele of the canal of the Nuck extending from the abdominal cavity to the inguinal canal was considered useful.