肝内結石症を伴った先天性胆嚢欠損症の１例 [in Japanese] A Case of the Absence of the Gallbladder with Intrahepatic Gallstones. [in Japanese]
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肝内結石症を伴う胆嚢欠損症を経験したので, 詳細を検討しえた胆嚢欠損症の本邦報告例96例の集計結果とともに報告する. 症例は59歳の男性で, 特に症状はないが検診にて胆石症を疑われ精査を行った. 肝内結石症と慢性萎縮性胆嚢炎と診断され, 手術を施行するが, 胆嚢は認められず, 拡張した総胆管と胆嚢管の遺残と思われる小隆起を認めるのみで, 肝亜区域切除のみを行った. 集計しえた96例のうち73例において, 総胆管非拡張は24例 (32.8%), 総胆管拡張例は26例 (35.6%), 総胆管拡張に総胆管結石を認めた例は23例 (31.5%) であり, また非拡張例の平均年齢は41.3歳, 拡張例は55.6歳そして結石合併例は60.4歳であり, 非拡張例と, 拡張例あるいは結石合併例との間には有意に年齢の差を認めた. また96例の胆嚢欠損症のうち, 肝内結石症を認めた症例は自験例を含めわずか6例であり, きわめて稀な症例と思われた.
A case of absence of the gallbladder and a review of 96 reports from the Japanese literature are reported. A 59-year-old man received laparotomy under the diagnosis of chronic cholecystitis and intrahepatic gallstones. At surgery a small lump which seemed to be a cystic duct and the dilated common bile duct were observed, but the gallbladder was not identified. Hepatectomy (S3) was performed for intrahepatic gallstones. Of the 73 reported cases in which complications were discussed, the common bile duct appeared to be normal in 24 cases (32.8%) and was dilated in 26 cases (35.6%). Twnety three cases also had choledocholithiasis with dilatation of the common bile duct. A significant difference in mean age was found between the group with the normal common bile duct and the group with dilatation or choledocholithiasis. In conclusion absence of the gallbladder makes the common bile ductdilate gradually, and some symptoms manifest with aging. 6 reports with the intrahepatic gallstone werefound including our case.
- The Japanese Journal of Gastroenterological Surgery
The Japanese Journal of Gastroenterological Surgery 29(8), 1802-1806, 1996
The Japanese Society of Gastroenterological Surgery