脇 英彦^{1, 2}, 上田 真喜子¹, 伊東 宏祐², 中島 隆善³, 生田 真一³, 相原 司³, 岸 清彦⁴, 山中 若樹³

Hidehiko WAKI^{1, 2}, Makiko UEDA¹, Kohsuke ITO², Takayoshi NAKAJIMA³, Shinichi IKUTA³, Tsukasa AIHARA³, Kiyohiko KISHI⁴, Naoki YAMANAKA³

¹森ノ宮医療大学臨床検査学科, ²明和病院臨床検査科, ³明和病院外科, ⁴明和病院内科

¹Department of Medical Technology, Morinomiya University, ²Department of Clinical Laboratory, Meiwa Hospital, ³Department of Surgery, Meiwa Hospital, ⁴Department of Internal Medicine, Meiwa Hospital

キーワード : intrahepatic lithiasis, hepatic venous anomalies, color Doppler, hepatectomy

肝静脈走行異常を伴う肝内結石症の一切除例を経験した．症例は60歳代女性，心窩部痛と左背部痛を自覚し受診．腹部超音波とCT検査で左葉肝内結石とその末梢胆管に拡張を認め，入院となる．Bモード像ではB2起始部に径15 mmの音響陰影を伴う高エコーを認めた．末梢側の肝内胆管は径10 mmと拡張していた．中肝静脈は下大静脈合流部付近で途絶していた．左肝静脈と右肝静脈の交通枝，中肝静脈と右肝静脈の交通枝を認めた．交通枝はカラードプラで血流方向を確認した結果，いずれも右肝静脈に向かっていた．本症例は肝内結石症に対して肝左葉切除を安全に施行することができた．超音波ドプラ法は交通枝の血流方向が確認できるため，このような肝静脈走行異常を伴う肝切除術式選択に有用な検査と考えられた．

We experienced a case of liver resection for intrahepatic lithiasis with hepatic vein abnormalities. A female in her sixties presented with epigastric pain. She was admitted after ultrasound and computed tomography indicated left lobe intrahepatic lithiasis and swelling of its peripheral bile duct. B-mode imaging indicated a high echo with posterior shadows with a diameter of 15 mm at the B2 junction. The intrahepatic bile duct on the peripheral side had swelled to a diameter of 10 mm. The middle hepatic vein was blocked in the vicinity of the inferior vena cava junction. The communicating branches of the left and right hepatic vein as well as communicating branches of the middle and right hepatic veins were indicated. Confirmation of the direction of blood flow using color Doppler indicated that the blood flow of all communicating branches was towards the right hepatic vein. This case could safely undergo left hepatic lobe resection for intrahepatic lithiasis. Since ultrasound makes it possible to identify the blood flow direction of the communicating hepatic vein branches, it is useful in improving the safety of liver resection with these types of hepatic venous flow abnormalities.