胆管細胞癌の再発様式からみた手術治療方針 MODES OF METASTASIS OF CHOLANGIOCELLULAR CARCINOMAS AND THE STRATEGIES FOR SURGERY

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1985年1月より1994年12月までの10年間に当院外科で切除した胆管細胞癌13例を対象とし,その進展様式と対策について検討した.<br> 病理組織学的所見では,肝内転移を4例,門脈侵襲を12例,静脈侵襲を7例に認めた.リンパ節転移は5例に認められ,その部位は,肝十二指腸間膜内リンパ節,総肝動脈幹リンパ節,大動脈周囲リンパ節であった.手術は2区域以上の肝切除を行ったが,切除断端癌浸潤陽性例が4例あった.再発は, 11例に認め,初回再発部位は膵頭後部リンパ節,大動脈周囲リンパ節と,残肝の頻度が高かった.予後は, 1, 3, 5年生存率85%, 34%, 25%と不良であった.<br> 以上より,胆管細胞癌は,血行性,リンパ行性転移の頻度が高く,手術に際しては充分な安全域をもった肝切除と広範なリンパ節郭清が必要である.

Thirteen cases of cholangiocellular carcinoma resected at the department in a recent one decade from January 1985 to December 1994 were subjected to a study on the modes of metastasis and strategies for surgery.<br> Histopathologically intrahepatic metastasis was noted in four cases; portal invasion in 12 cases; and venous invasion in seven cases. Five cases had lymph node metastasis, of which locations included lymph nodes of the hepatoduodenal ligament, lymph nodes around the common hepatic artery, and periaortic lymph nodes. Upon operation hepatic resection of more than two segments was performed and in 4 cases surgical stumps were positive. Recurrence was observed in 11 cases. The initial sites for recurrence were common in the retropancreatic lymph nodes, periaortic lymph nodes, and remnant liver lymph nodes. The prognosis was so poor that one-, 3-, and 5-year survival rates were 85%, 34%, and 25%, respectively.<br> These results indicate that cholangiocellular carcinomas often hematogenously and lymphogenously metastasize, and hence hepatic resection with sufficient surgical margin and extended lymph node dissection are recommended for surgery.

収録刊行物

  • 日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society

    日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society 57(6), 1335-1339, 1996-06-25

    Japan Surgical Association

参考文献:  16件中 1-16件 を表示

被引用文献:  3件中 1-3件 を表示

各種コード

  • NII論文ID(NAID)
    10008521755
  • NII書誌ID(NCID)
    AN00198696
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • ISSN
    03869776
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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