高度の炎症を伴う重複胆囊に対し腹腔鏡下胆囊亜全摘術を施行した1例

A case of double gallbladder treated by laparoscopic subtotal cholecystectomy

◆要旨：重複胆囊は稀な先天性奇形であり，胆道奇形を有する症例に対しては術前・術中の胆道検査を十分に行い，胆管損傷を回避することが重要である．症例は74歳，女性．腹部超音波検査で重複胆囊が疑われ，ERCP検査でGross分類type Bの重複胆囊と診断した．慢性胆囊炎の診断で腹腔鏡下胆囊摘出術を施行した．術中所見では慢性炎症のため副胆囊と肝門部の炎症性癒着が高度であり，胆管損傷のリスクが高いと判断して副胆囊に対し亜全摘術を行った．ICG蛍光造影を用いて副胆囊管開口部を確認し，安全に亜全摘術が施行可能であった．胆囊亜全摘術を行った症例では結石の再燃や遺残胆囊癌の報告もあり，長期的なフォローアップが必要である．

　Double gallbladder is a rare congenital malformation. In patients with biliary malformations, performing a thorough preoperative and intraoperative examination of the biliary tract is essential to avoid bile duct injury. We experienced a case of preoperatively diagnosed double gallbladder and performed laparoscopic subtotal cholecystectomy. A 74-year-old woman was suspected of having a double gallbladder on abdominal ultrasonography and was diagnosed as a Gross type B double gallbladder by ERCP. She underwent laparoscopic cholecystectomy based on the diagnosis of chronic cholecystitis with wall thickening by EUS. Due to chronic inflammation, intraoperative findings showed severe adhesion between the accessory gallbladder and hepatic hilum. Therefore, subtotal cholecystectomy was performed for the accessory gallbladder, considering the risk of bile duct injury. ICG was useful to confirm the opening of the accessory gallbladder duct, and subtotal cholecystectomy could be performed safely even for an accessory gallbladder. Long-term follow-up is necessary because the risk of gallbladder stone reformations and gallbladder cancer has been reported in patients who have undergone subtotal cholecystectomy.