小児の先天性胆道拡張症に対する完全腹腔鏡下肝外胆管切除・胆管形成を伴った肝門部肝管空腸吻合術

Total laparoscopic management for congenital bile duct dilatation in children

◆要旨：小児の先天性胆道拡張症に対する完全腹腔鏡下肝外胆管切除，肝管形成と肝門部肝管空腸吻合術について報告した．【対象】1～7歳の4例（IV-A型3例，Ic型1例）である．IV-Aの3例で左右肝管起始部に狭窄がみられた．【手術】完全腹腔鏡下に肝外胆管を切除し，肝門部で左右肝管を形成し狭窄を解除した後，大きな吻合口を作成し肝門部肝管空腸吻合術を行った．【結果】手術時間は平均478分．1例で胆汁リークがあったが5日で自然軽快．術後平均8.8日で退院した．【結語】本症の胆管狭窄は，肝門部近くが多く，腹腔鏡下手術においても比較的容易に対処可能である．術後の回復や美容面で優れており，症例によっては従来の術式に代わる優れた方法である．

　This paper introduces a total laparoscopic management for congenital bile duct dilatation（CBD）in children. We performed total laparoscopic excision of the extrahepatic duct, bile duct plasty of the stenotic hepatic ducts, and wide hepaticojejunostomy at the hepatic hilum in 4 children with CBD. The median age was 4 years（range 1 year to 7 years）. Three children had type IV-A and one had type Ic cyst. All patients underwent successful laparoscopic procedures. One patient had a postoperative bile leak for five days. The mean operation time was 478 min. The average length of hospital stay after surgery was 8.8 days. A cosmetic result was excellent, and all patients were asymptomatic. Ductal stricture is frequently observed around the hepatic hilum, and ductoplasty on laparoscopy appears to be possible. In conclusion, the laparoscopic management for CBD may be an attractive treatment option.