肝内胆管の狭窄に起因すると思われる肝内結石症の1例

Hepatolithiasis with Stricture in the Left Hepatic Duct, Report of a Case

要旨　われわれは最近，肝内胆管の狭窄に起因すると思われる肝内結石症を経験したので，その狭窄部の病理学的検討を加えて報告した．本疾患は最近の医療技術の進歩により，比較的容易に診断が可能となった．特にERCPなどで狭窄のために肝内胆管が十分造影されない揚合の超音波下PTCの有効性は高い，本症例は狭窄部を含めた肝左葉切除術が施行され，現在まで順調に経過している．狭窄部を病理学的に検討すると狭窄部は胆管壁によく似た構造をしており，われわれは先天性胆管隔壁が炎症のためにこのような肥厚性狭窄に変化したものと推測した．以上より本症の治療は狭窄部を含めた肝切除術が最も理想的であると確信した．

　A 58 year-old woman was admitted to our hospital with a chief complaint of high fever and pain in the right hypochondrium. With ultrasonic-guided PTC a diagnosis of primary hepatolithiasis with stricture in the left hepatic duct was made (Fig. 1).

　Recent progress of medical technology has enabled us to easily diagnose this disease. Ultrasonic-guided PTC is very effective especially when, owing to stricture, the hepatic duct cannot be sufficiently delineated.

　The patient has made favorable progress after she underwent left hepatectomy including the strictured area (Fig. 2). We made a pathological examination of the strictured area of the resected liver and explored the pathogenesis of this disease. We found that, histologically, the strictured area was similar to the wall of the bile duct. We presume that a congenital septum of the bile duct causes cholestasis and lithogenesis, resulting in repeated chronic cholangitis, which in turn causes hypertrophic stenosis (Figs. 3-6).

　In conclusion, we are convinced that hepatectomy including the strictured area is the most ideal therapy for this disease.