右肝動脈による総肝管圧迫の1症例

Compression of the Common Hepatic Duct by Right Hepatic Artery in a Case with Cholecystolithiasis

　管腔臓器が隣接する血管によって圧迫され，生理的あるいは病的狭窄をきたすことは，大動脈やaberrant subclavian arteryによる食道狭窄¹⁾，上腸間膜動脈による十二指腸閉塞²⁾³⁾，腎動静脈による腎孟，尿管の圧迫⁴⁾などが従来よりよく知られているが，胆道系に対する血管系の圧迫症例の報告は比較的少ない¹³⁾．著者らは胆囊結石症の1例に術前にERCPを施行し，総肝管に限局性の陰影欠損を認め，肝動脈造影および手術によりそれが右肝動脈による圧迫であることを確認しえたので報告し，若干の文献的考察を加えた．

　A case with compression of the common hepatic duct by right hepatic artery is reported in this paper.

　A 38-year-old man complained of right hypochondral pain with nausea. Physical examination on admission revealed the patient in good nutritional state. Only serum alkaline phosphatase was a little elevated. No cholangiogram was obtained by drip infusion cholangiography, and only the round calcified shadow, 7×7 mm in diameter, was visible.

　Endoscopic retrograde cholangiogram showed a localized defect of the common hepatic duct. By angiogram it was diagnosed as it a compression by the right hepatic artery. By operation right hepatic artery crossing the anterior part of the common hepatic duct was comfirmed.

　There are many diseases with the defect of the common hepatic duct as revealed by cholangiography such as polyp, gallstone, Mirrizi's syndrome and so on. Right hepatic artery usually crosses the posterior part of common hepatic duct but scarcely anterior as in our case. Other vessels, for example, right gastric artery, cystic artery and collateral portal vein with portal hypertension, cross the anterior part of the common bile duct.