完全腹腔鏡下に胆管切除・胆管空腸Roux-en-Y再建を施行しえた膵・胆管合流異常の1例

A case of pancreaticobiliary maljunction treated by laparoscopic resection of the dilated area of the common bile duct and Roux-en-Y choledochojejunostomy

◆要旨：胆管拡張型の膵・胆管合流異常症に対し，完全腹腔鏡下に胆管切除，胆管空腸吻合術を施行しえた1例を報告する．患者は56歳，男性．S状結腸癌術後，経過観察中に胆管拡張を指摘され，精査にて胆管拡張型の膵・胆管合流異常症の診断となった．胆道内に腫瘍性病変を認めなかったため，腹腔鏡下に一部膵内胆管を含めた拡張胆管切除およびRoux-en-Y法による胆管空腸吻合術を施行した．膵・胆管合流異常症に対する分流手術は若年者に行われることも多く，完全腹腔鏡下に行う意義は大きいと考えられる．本邦では胆管空腸R-Y再建施行時は通常小開腹を併用しているが，本例は完全腹腔鏡下に施行した本邦初の報告である．

A 56-year-old man had been followed after sigmoidectomy for sigmoid colon cancer. Follow up CT showed that the common bile duct was dilated. We diagnosed the case as an anomalous connection between the choledochus and the pancreatic duct associated with dilatation of the common bile duct by ERCP and MRCP. No tumorous growth was found in the common bile duct, so we performed laparoscopic dilated common bile duct resection and Roux-en-Y choledochojejunostomy. Standard surgical procedure for pancreaticobiliary maljunction with dilatation of the bile duct is bile duct resection and biloenteric reconstruction. Common bile duct resection and Roux-en-Y choledochojejunostomy is often performed for younger patient, so it is beneficial to perform the surgery laparoscopically. In Japan, Roux-en-Y choledochojejunostomy is usually perfomed under a small incision in the abdomen. We report the first case of pancreaticobiliary maljunction treated by totally laparoscopic resection of the dilated area of the common bile duct and Roux-en-Y choledochojejunostomy.