術中蛍光胆道造影にて副肝管を同定しえた腹腔鏡下胆囊摘出術の1例

A case of laparoscopic cholecystectomy with aberrant bile duct detected by intraoperative fluorescent cholangiography

◆要旨：術中蛍光胆道造影にて副肝管を同定し，安全に腹腔鏡下胆囊摘出術を施行することができた症例を経験した．患者は71歳，女性で，総胆管結石に対して内視鏡的乳頭切開術後に採石し，その後腹腔鏡下胆囊摘出術を行った．術中に総肝管から右に分枝する副肝管を術中蛍光胆道造影にて同定し，損傷することなく手術を終了した．蛍光胆道造影は静注されたインドシアニングリーンが胆汁中に排泄されることを利用し，これに赤外線を当てその蛍光をカメラで捉える全く新しい術中胆道造影法である．剝離操作を要することなく胆管を透見することができ，手術の進行とともにその視野毎に何度でも胆管の走行を確認できる，安全で有用な術中胆道造影法と考えられた．

　We experienced a case of laparoscopic cholecystectomy（LC）with an aberrant bile duct detected by intraoperative fluorescent cholangiography. A 71-year-old woman underwent LC after removal of stones in the common bile duct by endoscopic sphincterotomy. The aberrant bile duct, which branched from the right side of the common hepatic duct, was detected by intraoperative fluorescent cholangiography, and LC was performed safely. Fluorescent cholangiography is new intraoperative cholangiography（IOC）technique that can show bile fluorescence on an infrared camera because injected indocyanine green is excreted into bile. Fluorescent cholangiography is a safe and useful IOC technique that can be used to visualize the bile duct without any dissection as well as to confirm the anatomy of the bile duct during surgery.