肝外門脈閉塞症合併例に対する3DシミュレーションとICG蛍光胆道造影法を用いた腹腔鏡下胆囊摘出術

Laparoscopic cholecystectomy using 3D simulation and indocyanine green fluorescence guide for patients with extrahepatic portal vein obstruction

◆要旨：症例は43歳，女性．33歳の流産時に門脈閉塞症と診断された．右季肋部痛を伴う胆石症を認め，手術目的に当科へ紹介となった．造影CT検査で門脈は脾静脈合流部から肝門部まで完全閉塞しており，肝十二指腸間膜内に著明な側副血行路を認め門脈海綿状血管増生を呈していた．術前に3Dシミュレーションを用いて肝血流が保たれるように切離血管を想定し，術中はインドシアニングリーン（ICG）を用いた蛍光胆道造影を使用して不要な側副血行路の切離および胆管の損傷を回避し，腹腔鏡下胆囊摘出術を施行した．肝外門脈閉塞症例に対する腹腔鏡下胆囊摘出術において3Dシミュレーションと術中ICG蛍光胆道造影を用いた報告例はなく，文献的考察を加えて報告する．

　A 43-year-old woman was diagnosed with portal vein obstruction at the time of her miscarriage at 33-years-old. She had cholelithiasis with right quadrant pain. Contrast-enhanced computed tomography（CT） demonstrated complete obstruction of the portal vein and cavernous transformation of the portal vein within the hepatoduodenal ligament. To avoid the injury of unnecessary collateral flow and bile ducts injury, a laparoscopic cholecystectomy with the preoperative 3D CT simulation and the indocyanine green（ICG） fluorescence guide was performed. There was no intraoperative bleeding or bile duct injury. The postoperative course was satisfactory, and the patient was discharged 3 days after the operation. Preoperative 3D simulation and intraoperative ICG fluorescence guide for precise identification of collateral flow and biliary tract would be useful in safe laparoscopic cholecystectomy for patients with an extrahepatic portal vein obstruction.