腹腔鏡下手術を施行した胆囊十二指腸瘻・胆囊胆管瘻の1例

A case of chronic cholecystitis with cholecystoduodenal fistula and cholecystocholedochal fistula treated by laparoscopic surgery

◆要旨：患者は77歳，女性．右季肋部痛を主訴に来院し，急性胆囊炎の診断であったが手術に同意が得られなかったため保存的治療を行い軽快した．初回治療9か月目に胆囊頸部の結石嵌頓による慢性胆囊炎からの胆囊十二指腸瘻，11か月目に胆囊胆管瘻を伴うMirizzi症候群（TypeⅡ）と診断した．術前に内視鏡的経鼻胆管ドレナージ（ENBD）チューブを挿入し，一期的に腹腔鏡下手術を施行した．今回筆者らは，胆囊十二指腸瘻と胆囊胆管瘻を伴う胆石性慢性胆囊炎に対して術前にENBDチューブを挿入することで,術中に超音波による総胆管の位置確認および胆管瘻閉鎖後に胆道造影による胆管の評価をすることができ安全に腹腔鏡下手術で治療することができた．

　A 77-year-old woman was admitted to our hospital because of acute cholecystitis. We recommended cholecystectomy but she did not agree. We provided conservative treatment and she was discharged. However, we noticed a cholecystoduodenal fistula ninth month after the first treatment, and Mirizzi syndrome（Mcsherry typeⅡ） with cholecystocholedochal fistula in the eleventh month. We preoperatively underwent endoscopic nasobiliary drainage（ENBD） to perform cholangiography during the operation and to decompress the bile duct after the operation. We safely performed laparoscopic surgery in one stage. Laparoscopic surgery for cholecystoenteric fistula or Mirizzi syndrome is very difficult because of severe inflammation. We preoperatively evaluated the state of the gallbladder by ENBD. As a result, we were able to perform laparoscopic surgery safely.