先天性胆管拡張症に対し腹腔鏡下胆管切除・総肝管十二指腸吻合を施行した1例

A Case of Congenital Biliary Tract Dilatation Treated by Laparoscopic Resection of the Dilated Area of the Common Bile Duct and Anastomosis of the Bile Duct to the Duodenum

　30歳，女性の先天性胆道拡張症患者に，腹腔鏡下に総胆管拡張部切除および胆管十二指腸吻合を施行し良好な成績を得た．患者は，腹痛と黄疸を主訴に来院し，精査目的に入院した．ERCPでは，総胆管は主乳頭開口部より約1cmの部位で膵管と合流していた．合流部から膵上縁部までの胆管は狭窄しており，膵上縁部から総肝管部までの胆管は嚢腫状に拡張していた．総胆管の嚢腫状拡張を伴う膵・胆管合流異常と診断し，腹腔鏡下に総胆管拡張部切除および総肝管十二指腸端側吻合を施行した．術後5日目に食事摂取を開始し，10日目に軽快，退院した．本法は，適応を選択することにより，先天性胆道拡張症に対する侵襲の小さい優れた手術法になりうると考え，報告する．

A 30-years-old woman with congenital biliary tract dilatation underwent laparoscopic surgery with favorable result. The woman visited our clinic with chief complaints of abdominal pain and jaundice. She was hospitalized for further examination. Endoscopic retrograde cholangiopancreatography showed that the common bile duct joined the pancreatic duct at a point approximately 1 cm from the major papillary opening, that the bile duct between the joining point and the upper margin of the pancreas had narrowed, and that the bile duct between the upper pancreatic margin and the common hepatic duct had dilated in a cystic manner.