副交通胆管枝を温存しえた腹腔鏡下胆囊摘出術の1例

A case of laparoscopic cholecystectomy in which preserving the communicating accessory bile duct was possible

◆要旨：患者は59歳，女性．B型慢性肝炎の経過観察中，胆囊の隆起性病変を指摘され当院を紹介された．腹部超音波で胆囊体部に12×8mm大の広基性の隆起を認めた．内視鏡的逆行性胆管造影で右肝管から分岐し総胆管に合流する細い胆管が総胆管に伴走しており，その途中に胆囊管が合流していた．以上より，副交通胆管枝を伴う胆囊ポリープと診断し，腹腔鏡下胆囊摘出術を施行した．術中，肝門側から総胆管に向かう副交通胆管枝へ胆囊管が合流しているのを確認可能であった．病理組織検査では胆囊過形成ポリープの診断であった．副交通胆管枝は稀な胆管走行異常であるが，術前の内視鏡的逆行性胆管造影で副交通胆管枝の存在を把握でき，胆囊管を安全に処理して副交通胆管枝を温存することが可能であった．

　We report a case of a gallbladder hyperplastic polyp complicated by a communicating accessory bile duct （CABD）. A 59-year-old woman was referred to our hospital for an elevated lesion in the gallbladder. Ultrasonography detected a 12-mm gallbladder polyp, which did not show any potential for malignancy. Endoscopic retrograde cholangiography （ERC） revealed that the CABD was connected to the right hepatic duct and the common bile duct. The cystic duct was observed to be attached to the CABD, which was not identified clearly on computed tomography with drip infusion cholangiography （DIC-CT）. In our case, the cystic duct was not involved in a circuit formed by the CABD, common bile duct, and right hepatic duct. To preoperatively determine CABD, we performed laparoscopic cholecystectomy and carefully preserved the CABD. Histopathologic diagnosis was benign hyperplastic polyp of the gallbladder. CABD is a very rare biliary condition. An anomalous biliary system is a risk factor for intraoperative biliary injury. Surgeons must be careful while examining the biliary system by cholangiography such as DIC-CT or ERC before laparoscopic cholecystectomy.