漿膜下層浸潤胆嚢癌に対する至適術式の検討 [in Japanese] Surgical treatment for gallbladder carcinoma with subserosal invasion [in Japanese]
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教室で経験した漿膜下層(ss)浸潤胆嚢癌(以下ss胆嚢癌)44症例について解析し,術式の在り方について検討した. 5生率は50. 2%であった. 肝切除付加群で有意に予後が良好であったが,肝切除範囲の多少では有意差を認めなかった.膵頭十二指腸切除術(以下PD)群の3生率は83.3%と良好であったが,胆管切除群との間に有意差は無かった.郭清度D1以下群に比しD2以上群で予後は有意に良好で,とくに頸部,胆嚢管癌でその意義が伺われる傾向にあった.<BR>予防的系統的肝切除, 予防的リンパ節郭清としての胆管切除・PD付加の意義は不明瞭であった.D2以上のリンパ節郭清と肝切除を伴う根治的手術がss胆嚢癌の至適術式と考えられた.
We investigated clinicopathological factors and prognosis for appropriate operation for 44 patients who received resections for gallbladder carcinoma with subserosal invasion. Their 5-year survival rate was 50.2%. There was a significant difference in the survival rate between the patients with and without hepatectomy, whereas there was no survival advantage for the anatomical liver resection or partial hepatectomy group cornpared with the extended cholecystectomy group. However, the 3-year survival rate of patients who underwent pancreaticoduodenectomy was 83.3%; the outcome after pancreaticoduodenectomy was comparable to that after resection of the bile duct. A significant difference in the survival rate was observed between lympahadectomy with D2 and D0/1. In particular, the tendency was remarkable in the gallbladder neck and cystic duct carcinoma. The significance of anatomical liver resection, pancreaticoduodenectomy, and resection of the bile duct was indistinct. The presence of lymph node metastasis was an independent prognostic factor by multivariate analyses. These results suggest that radical resection with hepatectomy and lympahadectomy with D2 is the appropriate procedure for gallbladder carcinoma with subserosal invasion.
Tando 21(5), 630-636, 2007-12-31
Japan Biliary Association