左側胆嚢・右側肝円索に肝切除術を施行した肝門部胆管癌の1例 A CASE OF RESECTED HILAR BILE DUCT CARCINOMA IN WHICH THE RIGHT UMBILICAL PORTION WAS ASSOCIATED WITH THE LEFT-SIDED GALLBLADDER
左側胆嚢・右肝円策を伴う症例は稀であり,肝切除は容易でない場合も推定される.われわれは左側胆嚢・右肝円策を伴った肝門部胆管癌に肝切除術を行った症例を経験した.症例は57歳,女性. 2004年2月,検診にて肝機能の異常を指摘され精査目的にて入院.左右からの胆管造影にて,上部胆管から左肝内胆管および右肝内胆管にかけて狭窄を認めた.また, enhanced CTなどにて左側胆嚢・右肝円索を認めた.左葉切除,胆管切除術および肝内胆管空腸吻合術を施行した.左門脈枝のtrunkは極めて短くsleeve resectionが必要であったほか,長い右門脈のtrunk, 右胆管一次分枝を認めた.<br> 左側胆嚢・右肝円策例では肝内の解剖学的破格を伴うことが多いとされている.本症例では内側区域および肝静脈に破格がみられ,文献的検討を含め報告する.
The right umbilical portion associated with the left-sided gallbladder is very rare, but it is often accompanied by multiple anomalies of the liver, by which hepatectomy can not be feasible or becomes difficult. A 57-year-old woman was hospitalized with the diagnosis of bile duct cancer in February 2004. Percutaneous transhepatic biliary drainage (PTBD) was performed through the right anterior and left lateral hepatic duct, demonstrating a stricture from the superior bile duct (Bs) to the left (B1) and right hepatic bile ducts (Br). Enhanced computed tomography and arteriogrophy revealed the existence of the right umbilical portion (right-sided round ligament) and left sided gallbladder. A left lobectomy with caudate lobectomy and bide duct resection was performed. Hepatic-jejunostomy was accomplished by the Roux-en-Y method. A wedge resection of the portal bifurcation and interrupted transverse suture were needed. In addition, a long right portal vein trunk and a long right first bile duct branch were recognized during the operation.<br> It has been reported that various hepatic anomalies in the right umbilical portion are associated with the left-sided gallbladder. We, herein, refer to the anomalies of medial segment and hepatic vein in this case, with a review of the literature.
- 日本臨床外科学会雑誌 = The journal of the Japan Surgical Association
日本臨床外科学会雑誌 = The journal of the Japan Surgical Association 67(8), 1863-1867, 2006-08-25
Japan Surgical Association