胆囊摘出既往例における一期的腹腔鏡下総胆管切石術の工夫―内視鏡用胆管プラスチックステントチューブの使用―

A technique for laparoscopic choledocholithotomy in a single attempt for patients with a previous cholecystectomy : through the use of a bile duct endoscopic plastic stent tube

◆要旨：胆囊摘出既往例における総胆管結石症の治療は，内視鏡的切石術が第一選択とされるが，不可能な場合では外科的手術が行われる．当科では外科的手術として腹腔鏡下総胆管切石術を行い，切石後のドレナージとして総胆管内へ内視鏡用胆管プラスチックステントチューブを留置し，減圧したうえで総胆管の一期的縫合を行っている．本ステントチューブ留置法は胆道の減圧が可能なうえ，術後内視鏡下に抜去が容易であり，有用な手技である．

　Endoscopic stone removal is widely accepted as the primary treatment option for choledocholithiasis in patients with previous cholecystectomy. Surgery may be indicated when endoscopic stone removal failed. In our hospital, laparoscopic common duct exploration and suture closure of the duct is the method of choice. In such cases, we place a plastic stent tube in the common duct in an antegrade way via the choledochotomy at the time of surgery. This stent tube works as decompression drainage after surgery. This stent tube can easily be removed by endoscopy, eventually after surgery. We think this stent tube retention method is safe and effective for the patient in whom endoscopic stone removal is difficult to perform.