A 63-year old man visited our hospital for detailed examination of liver dysfunction discoved in a routine medical check-up. Abdominal US and EUS showed irregular thichening of the common bile duct, while ERCP showed stenosis and irregular rosary-like lesions in the lower bile duct. The diagnosis of primary sclerosing cholangitis was made on the basis of these findings. PTCS was conducted to determine the presence or absence of cholangiocarcinoma. The biliary mucosa was rough and showed redness, scars and diverticulum-like changes. No evidence of malignant findings was noted in any examinations, including histological examination of a biopsy specimens taken by cholangioscope. The stenosed portion of the bile duct was coagulated and bilated using micro-wave under PTCS and the drainage tube was withdrawn when hepatic function tests returned to normal after creating a percutaneous drainage route. Treatment using cholangioscopy seems to have been effective, since hepatic function has remained normal for 30 months since the correction of stenosis.

症例は６３歳男性で，腹部超音波検査，超音波内視鏡では総胆管は不規則な肥厚像を呈し，ＥＲＣＰでは下部胆管の狭窄と不規則な数珠状変化を呈した。原発性硬化性胆肝炎と診断したが，胆汁細胞診でクラス３ｂの結果を得たため，胆肝癌合併症の有無を確認する目的で経皮経肝胆道鏡（ＰＴＣＳ）を施行した。胆管粘膜は粗造で，発赤，はん痕及び憩室様所見を認めたが，悪性所見は認めなかった。経皮的ドレナージルートの設置後より肝機能は正常化したため，ＰＴＣＳ下にマイクロウェーブを用いて胆管狭窄部を凝固・拡張し，ドレナージチューブを抜去した。狭窄解除後３０ヶ月の現在まで肝機能は正常で経過している。

胆管炎；内視鏡検査；マイクロ波；物理療法；症例報告；ヒト；病気
M.S. BILIARY