腹腔鏡下胆嚢摘出術における胆管損傷例の検討

Bile duct injury during laparoscopic cholecystectomy

　腹腔鏡下胆嚢摘出術（LC）における胆管損傷について検討した．当院において最近12年間に施行したLC975例中，胆管損傷は7例（0.72％）に発生した（総胆管完全離断4例，総胆管部分損傷1例，総肝管部分損傷1例，右副肝管完全離断1例）．損傷は全例術中に診断され，原因は誤認3例，高度炎症3例，胆道走行異常1例であった．5例に胆管端々吻合，1例に肝管空腸吻合，1例に腹腔鏡下損傷部縫合閉鎖を施行した．端々吻合5例中3例に術後吻合部狭窄を合併し，2例にバルーン拡張術，1例に再手術を施行した．胆管損傷治療の予後は施行された治療法に影響されるため，直ちに適切な治療を行うとともに長期間の経過観察を行う必要がある．

In this study, we reviewed and discussed bile duct injuries during laparoscopic cholecystectomy (LC). From January 1993 to December 2004, 975 LCs were performed in our hospital for symptomatic or complicated cholecystolithiasis. Out of these cases, bile duct injuries occurred in seven patients (0.72%), including complete transection of common bile duct (n=4), partial injury of common bile duct (n=1), partial injury of common he-patic duct (n=1), and complete transection of an aberrant right hepatic duct (n=1). All of these injuries were recognized and repaired during operation.