臨牀消化器内科 Vol.17 No.10(5-1)


特集名 膵・胆管合流異常 -- 最近の話題
題名 治療 (1) 胆管拡張を伴う合流異常 b. 成人:総胆管拡張を中心に
発刊年月 2002年 09月
著者 原 均 大阪医科大学一般・消化器外科 / はら外科胃腸科クリニック
著者 土肥 健彦 大阪医科大学一般・消化器外科
著者 岩本 充彦 大阪医科大学一般・消化器外科
著者 井上 仁 大阪医科大学一般・消化器外科
著者 河合 英 大阪医科大学一般・消化器外科
著者 谷川 允彦 大阪医科大学一般・消化器外科
【 要旨 】 総胆管拡張を伴う膵・胆管合流異常症の治療は，肝外胆管切除を行い，胆道再建を行う分流手術が必要である．膵側胆管は総胆管と膵管の合流部で切離，肝側胆管は，戸谷IV-A型の症例では，肝門部で狭窄部を残さず，吻合口を大きくとるように心がけ，それ以外は，総肝管の部位で十分であると考えている．胆道消化管の再建術式は，肝管十二指腸吻合術，Roux-en-Y法による肝管空腸吻合術，肝管十二指腸間に有茎空腸を移植する空腸間置術などが採用されている．術後遠隔成績の検討より，成人例では，胆道消化管の再建術式は，Roux-en-Y法あるいは肝管十二指腸吻合術を採用することが好ましく，とくに戸谷IV-A型では，空腸間置術は禁忌である．肝管十二指腸吻合術後の術後胆管癌の発生を経験し，十分な経過観察が必要であると考えられた．
Theme Recent Issues of Pancreaticobiliary Maljunction
Title Surgical Treatment of Adult Pancreaticobiliary Maljunction
Author Hitoshi Hara Department of General and Gastroenterological Surgery, Osaka Medical College / Hara Clinic for Surgery and Gastroenterology
Author Takehiko Dohi Department of General and Gastroenterological Surgery, Osaka Medical College
Author Mitsuhiko Iwamoto Department of General and Gastroenterological Surgery, Osaka Medical College
Author Hitoshi Inoue Department of General and Gastroenterological Surgery, Osaka Medical College
Author Masaru Kawai Department of General and Gastroenterological Surgery, Osaka Medical College
Author Nobuhiko Tanigawa Department of General and Gastroenterological Surgery, Osaka Medical College
[ Summary ] To treat pancreaticobiliary maljunction with dilatation of the common bile duct, extrahepatic bile duct resection is performed and biliary tract reconstruction is generally performed.
The bile duct on the pancreatic side is cut at the confluence site between the common bile duct and pancreatic duct. In respect to the bile duct on the hepatic side, a large anastomotic orifice is made at the hepatic portal outside of the stenotic region in Todani type IV-A patients. A similar procedure is performed at the hepatic bile duct in other patients. For reconstruction of the biliary digestive tract, hepatoduodenostomy, hepatojejunostomy using the Roux-en-Y method, and jejunal interposition in which the pediculate jejunum is implanted between the hepatic duct and the duodenum are performed. The Roux-en-Y method or hepatoduodenostomy is performed for reconstruction of the biliary digestive tract in adults. In particular, jejunal interposition is contraindicated for Todani type IV-A patients. Furthermore, we encountered a Todani type IV-A patient who developed cholangiocarcinoma after hepatoduodenostomy. In patients undergoing hepatoduodenostomy, sufficient follow-ups are needed.
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