腹腔鏡下胆嚢摘出術における術中胆道造影—透視下胆嚢穿刺造影の有用性

Intraoperative Cholangiography for Laparoscopic Cholecystectomy: Usefulness of Intraoperative Cholecysto-Cholangiography under Fluoroscopy

　腹腔鏡下胆嚢摘出術における胆管損傷は重要な合併症であり，術中造影の目的の1つに胆管損傷の回避がある．術中に胆嚢管の同定を目的として術中透視下胆嚢穿刺胆道造影を施行し，その有用性について検討した．本法を施行した61例のうち撮影のみの19例の造影率は，胆嚢管78.9％，総胆管57.9％であったが，透視下に42例を行い，胆嚢管95.2％，総胆管83.3％と高い造影率が得られた．本法を施行することにより，今までに胆管損傷の合併症を認めていない．特に透視下に本法を行うことにより，術中造影はさらに安全かつ容易に施行でき，胆嚢管を処理する前に三管合流部の解剖を同定できるため，術中の胆管損傷回避に有用であると考える．

Intraoperative cholangiography during laparoscopic cholecystectomy is not only valuable for the detection of common bile duct stones, but also for delineating the anatomy of the biliary ducts, thus avoiding injuries to the biliary tract and identifing other abnormalities. Most surgeons in Japan make use of transcystic cholangiograghy. We performed a technique of cholangiography through the gall bladder (Cholecystocholan-giography ; CCG) before clipping or cutting the cystic duct, which has resulted in a rate of 95.2% of adequate cholangiograms under fluoroscopy and has proved to be easier and safer than the transcystic technique.