腹腔鏡下胆嚢摘出術中の右肝管切断後に肝管肝管端々吻合再建を行った1例

End-to-end Hepaticohepaticostomy for the Transected Hepatic Duct during Laparoscopic Cholecystectomy:A Case Report

　症例は腹腔鏡下胆嚢摘術中に右肝管を胆嚢管と誤認し切断され，術後の内視鏡的逆行性胆管造影にて診断された．切断された胆管は肝管肝管端々吻合を行い，ステントチューブを10か月間留置した．その後の経過は良好で，腹部CTでは明らかな肝内胆管の拡張もなく，術後5年目の現在，肝機能も正常に経過している．切離胆管の損傷範囲が軽度であれば，細径胆管においても胆道再建術として非生理的胆汁分流手術を回避できる胆管胆管端々吻合術が第一選択と成り得る術式の1つと思われた．

A 28-year-old woman who underwent laparoscopic cholecystectomy for gallbladder polyp developed continu-ous bile leak on the second postoperative day. Endoscopic retrograde cholangiography revealed the transected right hepatic duct. We performed repair surgery on the eighth postoperative day. The hepatic duct had been transected sharply and showed no heat injury by electrocautery. We therefore performed end-to-end hepaticohepaticostomy with retrograde transhepatic tube stent using a magnifying grasses (x 2.5). The stent tube was left there for 10 months.