右肝動脈前区域枝が胆囊前面を走行した胆囊総胆管結石症の1例

A case of cholecysto-choledocholithiasis with right hepatic artery passing anterior to the gallbladder

◆要旨：胆囊総胆管結石症の腹腔鏡下手術時に，右肝動脈前区域枝が胆囊頸部前面を走行し，胆囊底部の右側より肝に流入した稀な走行異常の症例を経験した．

　患者は69歳，男性．右季肋部痛を訴え，当院を受診した．MRCPでは胆囊内に陰影欠損を認め，さらに総胆管下部にも陰影欠損を認めた．胆囊総胆管結石症と診断し，腹腔鏡下手術を施行した．手術所見では胆囊壁の肥厚や軽度の炎症所見を認めた．胆囊管の剝離時に，胆囊頸部の前面に右肝動脈の前区域枝を認め，胆囊底部右側から肝右葉前区域に流入していた．胆囊動脈は走行異常の前区域枝から胆囊底部に分枝していた．術前に走行異常の把握と脈管処理時の注意深い手術操作の必要性が示唆された．

　This paper presents a rare case in which an anterior segmental branch of the right hepatic artery（RHA）passes anterior to the infundibulum and fundus of gallbladder and courses to the hepatic anterior segment.

　A 69-year-old man was admitted to our hospital with complaint of hypochondralgia. MRCP showed stones in the gallbladder, and a mild dilatation of the common bile duct and a filling defect in the lower bile duct. Laparoscopic operation was performed for cholecysto-choledocholithiasis. Laparoscopic dissection revealed an anterior segmental branch of RHA anterior to the infundibulum and fundus of the gallbladder. The cystic artery arised as a branch of this artery, supplying the fundus of gallbladder. Preoprative identification of arterial anomalies and careful procedures should help to reduce the incidence of arterial injuries during this operation.