胆嚢消化管瘻に対する腹腔鏡下胆嚢摘出術

Laparoscopic Cholecystectomy for Cholecystoenteric Fistula

　急性胆嚢炎，Mirizzi症候群，胆嚢消化管瘻に対する腹腔鏡下胆嚢摘出術（以下，LC）は，開始初期の頃は禁忌とされていた．したがって，LCの際に遭遇した胆嚢消化管瘻は開腹移行の適応とされてきた．われわれは400例のLC中，4例の胆嚢消化管瘻（胆嚢十二指腸瘻2例，胆嚢横行結腸瘻2例）を経験し，腹腔鏡下手術を試みた．2例はEndocutterで，2例は縫合および体内結紮で瘻孔を処理した．平均手術時間は231分であった．1例に術後軽度胆汁瘻を認めた．術後平均入院期間は12.8日であった．腹腔鏡下手術の基本手技に習熟した施設では，胆嚢消化管瘻は腹腔鏡下手術の禁忌とならず，積極的に施行してよい思われた．

In the early days of the procedure there were several accepted contraindications for laparoscopic cholecys-tectomy. Some of these were acute cholecystitis, Mirizzi's syndrome, and Cholecystoenteric fistula. There-fore, cholecystoentric fistula is generally considered an indication for conversion to open surgery during laparoscopic cholesystectomy.In a series of 400 laparoscopic cholecystectomies, we encountered four patients (three female, one male, mean age 68.5) of cholecystoentric fistula (two cholecystoduodenal fistula, two cholecystocolonic fistula) incidentally discovered during laparoscopic cholecystectomy.