副交通胆管枝の2例 [in Japanese] Two cases of communicating accessory bile duct [in Japanese]
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胆道系の分岐には様々な形態異常が知られており,副交通胆管枝もその1形態である.今回は布側肝管と胆嚢管を交通する副交通胆管枝の2例を経験したので報告する,症例1は68歳, 女性. 症例2は63歳, 男性. 両症例とも閉塞性黄疸にて紹介入院となった. PTBDの精査造影の際に,右肝管と胆嚢管を交通する副交通胆管枝の存在が判明した.症例1は進行胆管癌,症例2は膵頭部癌の診断で膵頭十二指腸切除術が施行された.両症例とも,副交通胆管枝は肝に単独の支配領域を有さず,右肝管に胆汁流出の障害となるような狭窄などが認められないことから,副交通胆管枝の処理は結紮切離のみで対応した.今回の副交通胆管枝は直接造影で発見されたが, MRCPやDIC-CTによる発見の報告も増加しており, 今後同検査の普及, 発展により,直接胆道造影を用いずとも胆道走行異常の詳細な検討が非侵襲的に行えるようになる可能性があると考えられる.
It is known that biliary system branching shows various morphological abnormalities including accessory communicating bile duct. In this study, we report 2 patients with an accessory bile duct communicating between the right hepatic duct and the cystic duct. Patient 1 was a 68-year-old female. Patient 2 was a 63-year-old male. The two patients were referred and admitted to our hospital for obstructive jaundice. Detailed cholangiography prior to PTBD revealed the presence of an accessory bile duct communicating between the right hepatic duct and the cystic duct.<BR>Pancreatoduodenectomy was performed under diagnoses of advanced cholangiocarcinoma and pancreatic head cancer in Patients 1 and 2, respectively. In these patients, the accessory communicating bile ducts did not have any single dominant region in the liver, and there was no stenosis affecting bile outflow in the right hepatic duct. Therefore, ligation was performed to treat the accessory communicating bile ducts. These abnormalities in the present cases were detected on direct cholangiography. However, such abnormalities have been increasingly detected on MRCP or DIC-CT. In the future, the widespread use and development of these procedures may facilitate the noninvasive evaluation of abnormalities in the biliary course without direct cholangiography.
Tando 21(5), 659-664, 2007-12-31
Japan Biliary Association