腹腔鏡下胆囊摘出術時における肝外胆管・胆囊管合流形態の画像診断―DIC-CTとMRCの比較―

Imaging diagnosis of the structure of the bile duct and the cystic duct in laparoscopic cholecystectomy : comparison with DIC-CT and MRC

◆要旨：胆管合流形態は多岐にわたり，正常肝区域の胆汁排泄経路として肝外で異所性に合流する異所性胆管はわずか直径1～2mmであり，腹腔鏡下胆囊摘出術を施行する際その損傷は重篤な合併症を引き起こす．今回，DIC-CTとMRCを用いて，胆管・胆囊管の分岐合流・走行形態についてレトロスペクティブに比較検討した．DIC-CTでは，ほぼ全例で総胆管と胆囊管の立体的位置関係が明確に描出された．一方，MRCでは胆囊管合流部が描出されていないことが多く，MRCよりDIC-CTのほうが画像の描出に優れていた．異所性胆管は，DIC-CTで13.5％に認めた．DIC-CTは多くの施設で施行可能であり，術前検査として有用である．

　There are various forms of branch for the bile duct and the diameter of an aberrant extra-hepatic bile duct is only 1～2 mm. The injury to this duct during laparoscopic cholecystectomy can cause critical complications. The current study reviewed the structure of the bile duct and the cystic duct using DIC-CT and MRC. The 3-D relationship between the cystic duct and the common bile duct（CBD）was visualized clearly in all the cases by DIC-CT. On the other hand, MRC could not visualize the joining of the cystic duct in many cases. These structures were visualized more clearly in DIC-CT than in MRC. Aberrant bile ducts were visualized 13.5%in DIC-CT. DIC-CT is useful and should be performed before the operation.