胆管癌における上流側胆管の癌先進部の臨床病理学的研究 A clinicopathological study on the proximal border of bile duct carcinoma

博士論文

胆道癌取扱い規約に表層型, 表層拡大型を加え胆管癌46例の上流側の癌先進部を臨床病理学的に検討した. 表層型, 表層拡大型進展を伴う乳頭型, 結節浸潤型, 浸潤型の癌先進部は粘膜層にあり, 上流の非癌部の胆管より粘膜の丈が高く肥厚していたが, 線維筋層, グリソン鞘の線維層の厚さは同定度であつた. 表層拡大型進展を伴わない結節浸潤型, 浸潤型の癌先進部は線維筋層, 線維層内にあり, 上流の非癌部胆管より線維筋層, 線維層が肥厚し, 胆管内腔の狭小化を認めた. 胆管癌の術前診断にはPTCSが有用で, 粘膜の顆粒状変化, 腫瘍血管の有無に着目し, 選択的胆管造影では壁不整像, 狭窄所見の範囲を読影し, 術前に胆管の切除線を決定すべきである.

We studied the clinicopathological characteristics of the proximal border of bile duct cancer among 46 cases. In both the superficial and the superficially spreading type, cancer was located within the mucosa and the mucous membrane at its verge was more hypertrophic than the proximal noncancerous mucosa, but they didnt differ from each other in thickness at the fibromuscular and Glissons fibrous layer. In bile duct cancer without superficial spread, on the other hand, the tumor involve the fibromuscular or Glissons fibrous layer and fibromuscular or Glissons fibrous layer at their verge was more hypertrophic than the proximal noncancerous bile duct, which resulted in the narrowing bile duct at the lesion. Percutaneous transhepatic cholangioscopy (PTCS) facilitates the preoperative diagnosis of the extent of the bile duct cancer, which shows a granular change of the mucosa and tumor vessels. The wall irregularity and narrowing of the bile duct demonstrated by the selective cholangiography are also referred to its extent.

名古屋大学博士学位論文 学位の種類 : 博士(医学)(論文) 学位授与年月日:平成4年4月3日 山瀬博史氏の博士論文として提出された