後螺旋型合流胆囊管にMirizzi症候群を発症した急性胆囊炎に腹腔鏡下胆囊摘出術を施行した1例

Laparoscopic cholecystectomy for patient with Mirizzi syndrome at the left posterior spiral of the cystic duct : a case report

◆要旨：後螺旋型合流胆囊管にMirizzi症候群を発症した症例を経験した．患者は急性胆囊炎にて入院した90歳，女性．胆囊管が総胆管の後面をまわって合流している胆囊頸部に胆石が嵌頓し，結石前面にある総胆管を圧排し，それが原因で胆管の狭窄と結石嵌頓による急性胆囊炎を起こしていた．抗生剤にて軽快せず，腹腔鏡下胆囊摘出術を行った．手術は順行性に胆囊を肝床部から切離した．肝床部には膿状の液体が貯留し，総胆管の後面を胆囊頸部に沿って剝離した後，胆囊頸部で胆囊を切離した．術後行ったDIC-CTで狭窄は解除された．

　We experienced a case of Mirizzi syndrome in a 90-year-old woman. The patient was hospitalized for acute cholecystitis. The cystic duct of the patient formed a posterior spiral that drained into the common hepatic duct from the left side. Gallstone was incarcerated in the gallbladder neck, which was located in the posterior side of the common bile duct. Acute cholecystitis due to calculus impaction and obstructive jaundice was noted. Diagnosis of Mirizzi syndrome was made. Because the antibiotics were ineffective, antegrade laparoscopic cholecystectomy was conducted. Surgical findings showed purulent liquid that accumulated in the liver bed. Meticulous dissection was made between the posterior surface of the CBD and the gallbladder neck. Postoperative DIC-CT showed that the stenosis had been relieved.