Mirizzi症候群を合併した気腫性胆嚢炎に対する腹腔鏡下胆嚢摘出術の1例

A Case of Laparoscopic Cholecystectomy for a Patient with Emphysematous Cholecystitis with Mirizzi Syndrome

　症例は50歳，男性．腹部単純X線と腹部CT検査で胆嚢内に結石とガス像が認められた．胆道造影では胆嚢頸部嵌頓結石と3管合流部総胆管の狭窄像を認めた．胆嚢ドレナージ後，23日目に腹腔鏡下胆嚢摘出術を施行した．術前の胆道造影では3管合流部総胆管の狭窄像は軽快していた．胆嚢壁は著明に肥厚して周囲組織と高度に癒着しており，胆嚢管の確認に難渋したが，術中胆道造影により胆嚢管遺残結石のないことを確認し，胆嚢管を切離した．手術時間は4時間45分，出血は少量で，患者は術後13日目に退院した．気腫性胆嚢炎に対する腹腔鏡下胆嚢例は本邦では自験例が6例目で，うちMirizzi症候群合併例は自験例で2例目である．

The patient was a 50-year-old man. Stones and the presence of gas in the gallbladder (GB) were detected by plain abdominal X-ray and computed tomography (CT) scan. Cholangiography showed an incarcerated stones in the cystic duct (CD) and a stenosis of the the common bile duct (CBD). Laparoscopic cholecystectomy (LC) was performed on the 23rd day after the percutaneous transhepatic gallbladder drainage. Pre-operative cholangiography showed improved stenosis of the CBD. The GB showed remarkable wall thickning and there was severely adhered to the peripheral tissues, making the CD hard to recognize.