症例はBMI49の高度肥満症の43歳男性で， 4 日前からの食後に増悪する心窩部痛を自覚し前医を受診した．腹部造影CT検査で胆嚢腫大と壁肥厚を認め，胆嚢頸部には15mmの結石を認めた．急性胆石性胆嚢炎の診断で手術目的に当院外科紹介受診となった．
高度肥満のため手術台 1 台では対応できず，手術台を 2 台横並びに設置して手術を施行した．腹壁が厚くポートの可動制限を強く受け，患者の右季肋部に配置する術者左手のポートは距離も遠く，操作性は非常に悪かった．体位を変換することができず，視野展開のためにポートを 1 本追加し 5 ポートとすることで，腹腔鏡下胆嚢摘出術を施行可能であった．
高度肥満患者の急性胆嚢炎に対する腹腔鏡下胆嚢摘出術を経験したため報告する．
Surg, 2 : 29－31, 1992.
12）Sidhu RS, Rai PK, Treat RC, Scaarcipino MA and Tarr
1 ）急性胆管炎・胆嚢炎診療ガイドライン第 3 版．
SM：Obesity as a factor in laparoscopic cholecystectomy.
2 ）Abi-Haider Y, Sanchez V, Williams, SA, Itani KM:
Surg Endosc, 21: 774－776, 2007.
Revisiting Percutaneous Cholecystectomy for Acute
13）上田倫夫，関戸 仁，杉田光隆，遠藤 格，渡曾伸
Cholecystitis Based on a 10-Year Experience. Arch Surg,
治，嶋田 紘：手術手技 高度肥満例に対する腹腔
147: 416－422, 2012.
鏡下胆嚢摘出術．手術，60: 331－336，2006．
3 ）Harboe KM, Bardram L: The quality of cholecyctomy in
14）市原隆夫，福本聡志，野村英明，味木徹夫，黒田嘉
Denmark: outcome and risk factors for 20307 patients
和：肥満患者に対する牽引テープ法を用いた腹腔鏡
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下胆嚢摘出術．手術，55: 1611－1618，2001．
1641, 2011.
80
高度肥満症例への胆嚢摘出術
Abstract
A CASE OF LAPAROSCOPIC CHOLECYSTECTOMY FOR ACUTE CHOLECYSTITIS
IN AN EXTREMELY OBESE PATIENT
Shizune Onuma 1 ）, Shin Kato 1 ）, Atsushi Onodera 1 ）, Kazuya Endo 1 ）, Yui Honjyo 1 ）,
Shinsuke Suzuki 1 ）, Jyunya Shirai 1 ）, Teni Godai 1 ）, Yutaka Kumagiri 1 ）,
Yuji Yamamoto 1 ）, Shinichiro Suzuki 1 ）, Yasushi Rino 2 ）, Munetaka Masuda 2 ）
1）
Department of Surgery, Fujisawa Shounandai Hospital
2）
Department of Surgery, Yokohama City University School of Medicine
The patient was a 43-year-old man with a 4-day history of exacerbation of epigastric pain after eating who
consulted his former doctor. Abdominal contrast-enhanced computed tomography examination showed an enlarged
gallbladder, thickened gallbladder wall, and a 15-mm stone in the neck of the gallbladder. Acute cholecystitis was
diagnosed, and the patient was referred to our hospital for surgery. His height was 183 cm, his weight was 165 kg,
and he was extremely obese, with a body mass index of 49 kg/m2. Since one operating table (overload resistance 120
kg, width 50 cm) could not accommodate him, two operating tables were placed side by side. One port was added to
secure the field of view, and laparoscopic cholecystectomy was performed using 5 ports. A case of a severely obese
patient who underwent laparoscopic cholecystectomy for acute cholecystitis is described.
81
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