総胆管結石症に対する腹腔鏡下切石術の検討

Study of laparoscopic choledocholithotomy for choledocholithiasis.

　過去4年間に腹腔鏡下の総胆管結石切石術を試みた43例を対象に，その手術術式と適応について検討した．開腹移行例は10例で，このうち7例は急性胆嚢炎併発例であった．21例に経胆嚢管的切石，12例に総胆管切開切石が行われた．経胆嚢管的切石は，手術時間および術後の在院日数が短いことから第一に選択すべき術式と思われるが，結石径が10mm以上，あるいは結石数3個以上の症例では総胆管切開切石が適応と思われた．また，総胆管切開切石後の総胆管一期的縫合では，切石後の胆道造影は不可欠であり，遺残結石がなく，造影剤の十二指腸への流出が良好で，総胆管径が10mm以上の症例に対して適応と思われた．

The method of laparoscopic choledocholithotomy and its indication were studied in 43 cases of choledo-cholithiasis. In 10 cases, laparoscopic surgery was converted to open surgery. Among the 10 cases, seven involved acute cholecystitis. Transcystic choledo-cholithotomy was carried out in 21 cases. The average diameter of common bile duct (CBD) stones was 7.0± 3.1 mm. In 4 cases, transcystic lithotripsy with laser lithotriptor was required for large CBD stones (more than 10 mm in diameter). The average operating time of this procedure was 174.8 min, but comparatively longer in cases with more than 3 CBD stones.