胆嚢管嵌頓結石に対する腹腔鏡下手術

Laparoscopic surgery for impacted stones in the cystic duct

　胆嚢管の三管合流部近くに結石が存在する場合，結石を除去したのち胆嚢管を処理する必要がある．このような胆嚢管嵌頓結石11例に対し腹腔鏡下手術を施行した．6例は胆嚢管内に結石を認め，他の5例は三管合流部に結石を認めた．経胆嚢管的に胆道鏡を挿入して截石したものが6例，結石が動かないため胆嚢管を三管合流部方向に縦切開し結石を摘出したのち切開部を縫合・閉鎖したものが5例あった．どちらの方法でも結石の一部は総胆管に落ちることが多いため，経胆嚢管的に胆道鏡を総胆管まで挿入することが必須であった．手術は全例腹腔鏡下に完遂できた．術後合併症は腹腔内にこぼれた結石による膿瘍を1例経験した．術後平均在院日数は13（4〜38）日であった．

When biliary stones are at the proximal side of the cystic duct, it is necessary to remove stones before resecting and closing the cystic duct. This study was conducted on 11 cases who had undergone laparoscopic surgery for such impacted stones in the cystic duct. Six cases had stones only in the cystic duct, while the other 5 cases had stones in the confluence. In the 6 patients, the stones were removed by trans-cystic cholangioscopy. In the other 5 patients, the cystic duct was cut down to the confluence longitudinally and the stones were re-moved.