合流部結石に対する内視鏡下手術

Laparoscopic Surgery for the Confluence Stone

　内視鏡下に治療を行った合流部結石3例についてその治療成績，問題点を検討し，手術適応の拡大の可能性について考えた．症例は70〜78歳の女性で，黄疸にて入院しPTBD,ERCPにより診断された．術式は，萎縮した胆嚢を切開し結石を摘除したのが2例，経胆嚢管的に結石を破壊し，胆嚢の部分切除を行った症例が1例であった．全例内視鏡下に手術を遂行しえた．手術時間は平均276分，入院期間は28日であり，合併症は認められなかった．合流部結石に対する内視鏡下手術は，経験の豊富な施設，術者においては治療法の選択肢の1つとなりえると思われる．

Confluence stone has been considered as contra-indication for laparoscopic surgery. But recently with the de-velopment of techniques and instruments, indication is expanding. We have experienced 3 patients with the con-fluence stone successfully treated by laparoscopic operation. Method of diagnosis was PTBD in 2 patients and ERCP in 1 patient. Operative procedures were trans-cystic lithotomy without cholecystectomy in 2 patients and trans-cystic duct lithotomy with cholecystectomy in 1 patient. The mean time of operation was 276 minutes and the mean time of hospital stay was 28 days.