重症急性膵炎を発症した若年者膵・胆管合流異常に対し腹腔鏡補助下分流手術を施行した1例

A case of laparoscopy-assisted surgery for pancreaticobiliary maljunction with severe acute pancreatitis

◆要旨：患者は25歳，女性．上腹部痛を主訴に当院内科を受診し，重症急性膵炎の診断で緊急入院となった．薬物療法で軽快し，原因精査で胆管非拡張型膵・胆管合流異常を指摘された．当科紹介となり，重症急性膵炎発症から4か月後に腹腔鏡補助下分流手術（総肝管空腸Roux-en-Y吻合）を施行した．肝外胆管は，膵側は膵上縁，肝側は左右肝管合流部レベルで切離した．総肝管空腸吻合は腹腔鏡下に連続縫合で行った．術後は合併症なく経過し，術後6日目に退院となった．膵・胆管合流異常に伴う膵炎が重症化することはきわめて稀である．重症急性膵炎を発症した合流異常に対し腹腔鏡下手術を施行した報告はなく，本邦初の症例と考えられた．

A 25-year-old woman presented to our hospital for upper abdominal pain. She was admitted with severe acute pancreatitis and underwent medication treatment. The examinations performed to investigate the cause of severe acute pancreatitis, revealed pancreaticobiliary maljunction. After the recovery of severe acute pancreatitis, we performed laparoscopy-assisted resection of the extrahepatic bile duct and Roux-en-Y hepatocholangiojejunostomy. The extrahepatic bile duct was dissected at the level of superior border of pancreas and common hepatic duct. Hepatocholangiojejunostomy was made with continuous suture under laparoscopic view. Postoperative course was uneventful and the patient was discharged on the 6th postoperative day. Pancreaticobiliary maljunction often presents with acute pancreatitis, but pancreatitis grade in most cases is mild. This is the first case of laparoscopy-assisted surgery for pancreaticobiliary maljunction after the treatment of severe acute pancreatitis.