肝内結石症の治療―肝切除を中心に

Treatment of Intrahepatic Stones: A Special Reference to Hepatic Resection for the Surgical Management

要旨　肝内結石症68例を検討し，肝切除術の本症治療上の意義を考察した．結石の局在，胆管形態異常（狭窄・拡張）は左葉に多く，右葉のみのものは少なかった．狭窄例は68例中44％にみられた．肝切除は左右肝管のいずれかの狭窄例の60％，それより末梢の狭窄例の50％に施行した．切除肝の組織学的検索では，胆管周囲の線維組織内に密在する腺管様構造が多数みられ，これらは粘液産生性で，器質的変化は高度であった．治療成績は，高度の狭窄例では切除群に良好で，94.4％が社会復帰した．非切除群の良好例は76.9％であった．すなわち，高度の胆管障害例では胆管の器質的変化も著明で，肝切除が有効と思われた．

　Evaluation of the hepatic resection as a surgical management for the intrahepatic stones was studied in 68 cases.

　Stones were in both lobes in 44.1％ and in 42％ in the left. But only 13％ were found in the right lobe. The pathological findings of the bile ducts were strictures and dilatations. Forty four percent of the cases showed the stricture (Fig. 2). Sixty percent of them were in the left lobe. The dilatation of the intra- and/or extrahepatic bile ducts were found in 93％ of 68 cases (Fig. 3).

　The hepatic resection was performed in 57％ of the cases with marked bile duct stricture (Tables 2 and 3). Resected liver specimens were examined histologically. They showed conspicuous proliferation of mucin-producing gland-like structure in the thickened periductal area (Fig. 7).

　Ninety four percent of the resected cases showed good prognosis after operation. On the other hand, 76.9％ of nonresected cases with bile duct stricture were in good condition after surgery (Tables 2 and 3).

　It is concluded that the hepatic resection in the case with marked bile duct disorder will give us significantly better postoperative course, because the region with severe organic changes is removed by the procedure.