肝内結石症の2例―特に狭窄部胆管について

Stricture of Bile Duct in Hepatolithiasis, Report of Two Cases

要旨　肝内胆管の狭窄部位の病理組織学的検討をなしえた2症例を報告した．症例1は71歳男性で，左肝内結石症に対し肝左葉切除術を施行．左肝管起始部と約2.5cm上流の上外側区域胆管に狭窄が認められた．同部の病理組織学的所見では，胆管壁は線維化により肥厚し，線維化巣内に腺管様構造や，粘液細胞の増生を認めた．症例2は65歳女性で，左肝内結石症に対し肝左葉切除術を施行．左肝管起始部より2cm上流に認められた相対的狭窄部位の病理組織学的所見では，症例1と同様に腺管様構造や粘液細胞の増生があり，線維化を伴う胆管壁の内翻を認めた．

　Two cases of hepatolithiasis with the stricture in the intrahepatic bile duct were presented.

　Case 1; A 71 year-old man was transferred to our hospital because of residual stones in the left intrahepatic duct. Cholangiography through the indwelling T-tube showed numerous filling defects in the dilated left intrahepatic duct. He had a left hepatic lobectomy in June 1983. Macroscopic study of the resected specimen revealed the stricture of left hepatic and lateral segmental ducts. Histological findings of the stricture of left hepatic duct showed the thickening of duct wall with remarkable fibrosis and proliferation of pseudoductular structures and mucin-producing cells within it.

　Case 2; A 65 year-old woman complaining of right hypochondralgia was admitted to our hospital. Preoperative ERC revealed many filling defects in the dilated bile ducts and the web-like stricture in the left hepatic duct. She had a left hepatic lobectomy in August 1983. Macroscopic and histological findings of the strictures in the ducts were similar to those of case 1.