重複胆囊管を認めた胆囊結石症の1例

A case of gall bladder stone with double cystic duct

◆要旨：胆囊管の走行異常は多数の形態が存在するが，胆囊管が2本存在する重複胆囊管はきわめて稀である．患者は55歳，女性．2008年4月から右季肋部痛を認め胆囊結石症の診断にて入院した．術前の3D-DIC-CT，MRCPで重複胆囊管を認め腹腔鏡下胆囊摘出術を施行した．2本の胆囊管を吸収性クリップで結紮・切離し手術を終了した．

　重複胆囊管は術中の胆管損傷の原因となり得るため術前診断が重要である．今回筆者らは術前の3D-DIC-CT，MRCPにより重複胆囊管を診断でき，胆管損傷することなく腹腔鏡下胆囊摘出術が可能であったため若干の文献的考察を加え報告する．

　Morphological variation of cystic duct can be seen in large number of cases, but double cystic duct is rarely encountered. A 55-year-old woman complaining of a right upper abdominal pain was admitted to the hospital in 2008 with a diagnosis of cholecystolithiasis. The double cystic duct was diagnosed before the operation by 3 D DIC CT and MRCP,and the operation was performed. Two cystic ducts were ligated with clips and were resected. Preoperative diagnosis of double cystic duct is very important because double cystic duct causes intraoperative injury of the bile duct. We diagnosed a patient with double cytstic duct using 3 D DIC CT and MRCP, and performed laparoscopic operation with no injury of the bile duct. The case is reported with some literature review.