肝内型原発性硬化性胆管炎が強く疑われた1例 A CASE OF PRIMARY INTRAHEPATIC SCLEROSING CHOLANGITIS
症例は72歳男性.皮膚〓痒感を訴え,平成5年8月19日に近医を受診した.同医にて黄疸を指摘され,翌日当科に入院した.血液生化学検査では, T. Bil, ALP, γ-GTP, 抗核抗体が高値を示していたが, GOT, GPTは正常範囲内で,抗ミトコンドリア抗体は陰性であった.腹部超音波, CT, 胆道造影等の検査所見より,胆嚢内結石と肝内胆管の炎症性病変を最も疑ったが,肝門部の腫瘍性病変も否定できなかったため, 9月14日に開腹術を施行した.術中,肝門部の剥離露出および胆道内視鏡等を行ったが,肝門部に腫瘍性病変は認められず,よって胆摘,総胆管切開, T tube drainage, 肝および胆管の生検を行うにとどめた.病理組織像,胆道造影所見および臨床経過より肝内型原発性硬化性胆管炎が強く疑われた.
A 72-year-old man was seen at another hospital because of itching of the skin and pointed out icterus on August 19, 1993. The patient was admitted to the hospital on the next day. On blood biochemical tests, total bilirubin, ALP, γ-GPT, and anti-nuclear antibody levels increased, GOT and GPT were in normal limit, and anti-mitchondrion antibody was negative. From abdominal ultrasonography, CT, and cholan-giography, cholecystolithiasis and inflammatory lesion of the intrahepatic bile duct were strongly suspect-ed, but a possibility of tumorous lesion of the porta hepatis could not be ruled out. So laparotomy was performed on September 14. During operation the porta hepatis was exposed and cholangioscopy was done, but no tumorous lesion was detected in the region. Cholecystectomy, choledocotomy. T tube drainage, and biopsy of the liver and bile duct were carried out. Based on histopathologic picture, cholangiographic findings, and clinical course, the definite diagnosis of primary intrahepatic sclerosing cholangitis was made.
- 日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society
日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society 56(8), 1651-1655, 1995-08-25
Japan Surgical Association