Abstract
症例は59歳の女性で，胃癌検診の上部消化管造影検査で肝内胆管が造影され，消化管胆管瘻の疑いで紹介となった．上部消化管内視鏡で胃体中部小彎に胆汁が流出する開口部を認めた．MRCP，ERCPで左肝管から分岐する異所胆管像と総胆管内に陰影欠損像を認めた．以上から，重複胆管，総胆管結石症と診断し異所胆管切除，総胆管切開切石，胆囊摘出術を予定した．手術所見は異所胆管が小網内を左肝管から胃小彎へと走行していた．また，異所胆管に合流する2本の胆管を別に認めた．術中胆道鏡で2本の胆管は胆管正常粘膜を有し，走行から尾状葉胆管枝と考え，左副肝管と診断した．胆囊摘出，総胆管切開切石，胃部分切除を含めた異所胆管，左副肝管切除を行った．左肝管に近い副肝管は温存した．病理組織学的検査で異所胆管，副肝管ともに正常胆管壁で，悪性所見はなかった．重複胆管症と左副肝管を同時に認めた極めてまれな1手術例を経験したので報告する．
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