腹腔鏡下に摘出し得た磁器様胆囊の1例

Laparoscopical resection of a porcelain gallbladder : a case report

症例は65歳，女性．検診で磁器様胆囊を指摘された．術前検査にて胆囊癌合併の可能性は低いと考えられ，また胆囊管の石灰化がないので腹腔鏡下での摘出が可能と判断した．手技上の問題点として，（1）慢性炎症による大網および周辺臓器の癒着，（2）胆囊壁の硬化，および石灰化による胆囊の把持困難，（3）炎症による肝床部の剝離困難の3点が考えられたが，胆囊を穿孔させることなく摘出することができた．切除した胆囊は組織学的に悪性所見を認めなかった．磁器様胆囊は胆囊癌の合併頻度が高い疾患ではあるが，術前診断で胆囊癌合併の可能性が低く，かつ腹腔鏡下手術が可能と判断された症例に関しては，腹腔鏡下胆囊摘出術も選択肢になりうると考えられた．

　The patient was a 65-year-old woman whose medical check-up showed the presence of a porcelain gallbladder. Since preoperative examination suggested a low possibility of gallbladder cancer as a complication, and since no clacification was observed in the cystic duct, we considered that laparoscopic cholecystectomy could be performed. There were three possible problems in the surgery : （1）adhesion of the greater omentum and the surrounding organs due to chronic inflammation, （2）difficulty in grasping the gallbladder due to consolidation and clacification of the gallbladder wall, and（3）difficulty in exfoliating the liver bed due to inflammation. However, the gallbladder was actually removed without perforation, and no malignant histological findings were found in the gallbladder. Although gallbladder cancer is a high-frequency complication of porcelain gallbladder, our case suggests that laparoscopic cholecystectomy can be performed effectively when a preoperative examination suggests a low probability of gallbladder cancer as a complication.