腹腔鏡下胆嚢摘出術後の胆管径の変化：磁気共鳴胆管膵臓造影法による前向き研究

Bile duct diameter changes after laparoscopic cholecystectomy: a magnetic resonance cholangiopancreatography prospective study.

• Tomislav Pavlović
• Sanja Trtica
• Rosana Troskot Perić

抄録

AIM:

腹腔鏡下胆嚢摘出術後の肝内胆管径および肝外胆管径の拡張を磁気共鳴コランジア膵臓造影法で評価すること。

AIM: To assess the intrahepatic and extrahepatic bile duct diameter dilatation after laparoscopic cholecystectomy with magnetic resonance cholangiopancreatography.

方法:

胆石のために腹腔鏡下胆嚢摘出術を受けた患者は48名（女性35名、平均年齢54.58±11.83歳）であった。胆嚢摘出術前と3ヶ月後、6ヶ月後に肝内胆管と肝外胆管を測定した。直径は14点で前後方向と側方方向に測定した。

METHODS: Forty-eight patients (35 women, mean age 54.58±11.83 years) underwent laparoscopic cholecystectomy because of gallstones. The intrahepatic and extrahepatic bile ducts were measured before and three and six months after cholecystectomy. The diameter was measured in the anteroposterior and laterolateral direction at 14 points.

結果:

術前の直径と比較すると、近位部の総胆管径は胆嚢摘出術後3ヵ月後(P=0.006)と6ヵ月後(P=0.0001)に有意に拡大し、総肝管径は胆嚢摘出術後3ヵ月後(P=0.001)と6ヵ月後(P=0.003)に有意に拡大していた。003）；左右の肝内胆管は胆嚢摘出術後6ヵ月後に有意に拡幅していた（それぞれP<0.0001、P=0.01）；両肝葉の肝内胆管は胆嚢摘出術後3ヵ月後（P<0.0001）と6ヵ月後に有意に拡幅していた（P<0.0001）。

RESULTS: When compared with the preoperative diameter, the common bile duct diameter at the proximal part was significantly wider three months (P=0.006) and six months (P=0.0001) after cholecystectomy; the common hepatic duct was significantly wider three months (P=0.001) and six months (P=0.003) after cholecystectomy; the right and left hepatic bile ducts were significantly wider six months after cholecystectomy (P<0.0001, P=0.01, respectively); and the segmental intrahepatic bile ducts in both hepatic lobes were significantly wider three months (P<0.0001) and six months after cholecystectomy (P<0.0001).

結論:

本研究では、胆嚢摘出術後の有意な拡張は特定のポイントでのみ発生し、肝外胆管全体に沿ったものではないことが示された。また、主要な肝内胆管と分節的肝内胆管にも有意な拡張が認められた。

CONCLUSION: This study showed that significant post-cholecystectomy dilatation occurred only at certain points and not along the whole extrahepatic bile duct. We also found a significant dilatation of the main intrahepatic and segmental intrahepatic bile ducts.