ESWL後に腹腔鏡下経胆嚢管的採石術を行った総胆管結石症の1例

A Common Bile Duct Stone Treated by Laparoscopic Transcystic Bile Duct Exploration with ESWL

　症例は64歳，女性．胆石，総胆管結石による急性閉塞性化膿性胆管炎にて入院した．ENBDによる胆道ドレナージ後，胆嚢結石合併症例であり，乳頭機能を温存するため腹腔鏡下手術を考慮した．結石径が15mmと大きいため，術前にESWLを使用し破砕して経胆嚢管的に砕石し，術後6日目に退院となった．結石径が大きく，また急性閉塞性化膿性胆管炎に陥っている症例でも，ドレナージが良好であればESWLを併用し安全に腹腔鏡下手術を施行でき，総胆管結石症に対する有効な治療法であると考える．

A 64 year-old female was admitted to our hospital because of acute obstructive supprative cholangitis by common bile duct stone. After biliary drainage with ENBD, we considered laparoscopic surgery for the prevervation of Vater's papilla function. So we performed extracoporeal shock waves lithotripsy (ESWL) to the CBD stone 15 mm in a diametter, then operated choledocholithiasis and cholelithiasis by laparoscopic transcystic common bile duct exploration (LTCDE). We could successfully perform choledocholithiasis by LTCDE with ESWL even for cases with lage stone and AOSC after biliary drainage.