重複胆嚢管を伴う胆嚢結石症の2例 TWO CASES OF CHOLECYSTLITHIASIS WITH DOUBLE CYSTIC DUCT

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比較的稀な胆嚢管走行異常の一つである重複胆嚢管を伴う胆石症を2例経験したので報告する.症例1は60歳の女性で,検診での腹部超音波検査にて胆石および小隆起性病変を認めた.腹腔鏡下の術中胆道造影検査にて胆嚢の描出を認め右肝管に流入する別の胆嚢管構造を認めた.同管状構造より胆道造影を再施行し右肝管より分岐することを再確認し,胆嚢摘出術を施行した.症例2は46歳の男性で,胆嚢炎を繰り返す胆石症である.腹腔鏡下の術中胆道造影検査にて,胆嚢の描出を認め右肝管に流入する別の胆嚢管構造を認めた.重複胆嚢管と診断し,両胆嚢管を切離した後,胆嚢を摘出した.重複胆嚢管はまれな胆嚢管走行異常であり直接造影検査を行っても術前の確定診断は困難である.まれではあるが重複胆嚢管をも想定した術中胆道造影および術中操作の必要性が再認識された.重複胆嚢管についての報告も集積されつつあり,文献的考察を加え報告する.

"Double cystic duct" is a rare anomaly of the biliary duct system. Two cases of cholecystolithiasis with double cystic duct were encounted. The first patient was a 60-year-old woman in whom cholecystolithiasis was detected by abdominal ultrasonography at a medical check up. Laparoscopic cholecystectomy was performed in June 2004. Intraoperative cholangiography from the main cystic duct showed another cystic duct, which had diverged from the right hepatic duct. The second patient was a 46-year-old man who had recurrent bouts of right upper abdominal pain presumably due to cholecystolithiasis. Laparoscopic cholecystectomy was done in May 2006. Intraoperative cholangiography through the main cystic duct showed another cystic duct from the right hepatic duct. Double cystic duct was diagnosed. At surgery the gallbladder was removed after the both cystic ducts were transected.<BR>"Double cystic duct" is a rare unnatural run of the biliary duct system, and it can be a cause of intraoperative injury. It is difficult to detect this anomaly by conventional preoperative examinations. These cases suggest the importance of intraoperative cholangiography to avoid unexpected injury of the cystic duct during laparoscopic cholecystectomy. Clinical reports of double cystic duct have been accumulating, and we present the case, together with some bibliographical comments.

収録刊行物

  • 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 69(7), 1764-1769, 2008-07-25 

    Japan Surgical Association

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各種コード

  • NII論文ID(NAID)
    10021944915
  • NII書誌ID(NCID)
    AA11189709
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    13452843
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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