重複胆囊に対し腹腔鏡下胆囊摘出術を施行した1例

A case of laparoscopic cholecystectomy for double gallbladder

◆要旨：患者は58歳，男性．主訴は肝機能異常．他院で胆囊結石症と診断され当院に紹介された．US，CTで肝床部に2つの胆囊を認め，主胆囊内に結石が存在していた．MRCPで2つの胆囊管は別個に総胆管に合流するGross分類B型の重複胆囊と診断した．総胆管結石も認められたため，ERCPで採石した後，腹腔鏡下胆囊摘出術を施行した．手術は通常の4ポートで行った．2つの胆囊は同一の漿膜に覆われており，胆囊管同士は癒着していた．胆囊管を2つに剝離し各々にクリッピングし胆囊を摘出した．術後経過に問題なく術後4日目に退院となった．重複胆囊は非常に稀な胆道奇形の1つである．腹腔鏡下胆囊摘出術を行う際には，副胆囊の位置や胆囊管の合流部位などの解剖学的変異を把握することは合併症を回避するうえで重要である．

　A 58-year-old male was referred to our hospital for liver dysfunction and choledocholithiasis. Abdominal ultrasound and computed tomography （CT） showed two gallbladders in the gallbladder bed as well as stones in the main gallbladder. Magnetic resonance cholangiopancreatography （MRCP） revealed that each cystic duct communicated separately with the common bile duct （CBD） and there were stones in the CBD. The patient was diagnosed with a double gallbladder, classified as Gross type B, with CBD stones. After the CBD stones were removed via endoscopic retrograde cholangiopancreatography （ERCP）, laparoscopic cholecystectomy was performed. Four trocars were used at the usual placements. Both gallbladders were covered with the same serosa, and the two cystic ducts were adhered to each other. The cystic ducts were dissected, separately clipped, and divided. The gallbladders were then removed. The patient was discharged on postoperative day 4 with no postoperative complications. The double gallbladder is a rare congenital anomaly. When using laparoscopic cholecystectomy for patients with a double gallbladder, the surgeon should carefully identify the anatomy of the gallbladder and bile duct in order to avoid surgical complications.