胆嚢癌S<SUB>0</SUB>症例の壁深達度診断と手術方針  [in Japanese] Diagnosis and management for cancer of the gallbladder without invasion of serosa macroscopically (S<SUB>0</SUB>)  [in Japanese]

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Abstract

115例の自験胆嚢癌症例のうち,手術時肉眼的にS<SUB>0</SUB>の21例を対象に,癌進展度および予後からS<SUB>0</SUB>症例の手術方針を検討した.S<SUB>0</SUB>症例での壁深達度はm癌6例,pm癌2例,ss癌8例,se癌4例で,ss癌以上が60%も存在した.m・pm癌ではリンパ節転移,脈管侵襲ともになく,ss癌では半数にリンパ節転移,全例に脈管侵襲を認めた.se癌では全例にリンパ節転移,脈管侵襲を認めた.壁深達度別生存率ではm・pm癌は5生率100%,ss癌16.0%,se癌30.0%であった.<BR>以上から,術中に深達度がpmまでかss以上かの診断は重要で,その診断に術中エコーを用いているが,その成績は10例中9例にその深達度,肝浸潤を診断しえた.手術方針として術中エコーでpm癌までは肝床切除+R<SUB>2</SUB>,ss癌以上では肝床切除+胆管切除+R<SUB>2</SUB>,リンパ節転移状況,肝浸潤の程度により膵頭十二指腸切除また肝区域切除の追加が必要である.

The records of 20 patients, who had cancer of the gallbladder without invasion of serosa macroscopically at the operation were analysed. In all patients the gallbladder were resected and examined microscopically. Cancer was limited to muscularis in 8 patients (m in 6 patients, pm in 2 patients) and had spread beyond the muscle layer in 12 patients (ss in 8 patients, se in 4 patients). Lymphnodal metastases, lymphatic permeation and venous permeation were negative in m and pm patients. But in ss and se patients those permeation were found with high rate. The survival rates of the S<SUB>0</SUB> patients were computed by Kaplan & Meier's method. The 5-year survival rates were 100% in m and pm patients, 16% in ss patients and 30% in se patients. The patients whose lesions had spread beyond the muscle layer showed poor results.<BR>Intraoperative ultrasonographic examination was performed in 10 patients for diagnosis of invasion to the wall of the gallbladder. A correct diagnosis had been made in 9 of 10 patients.<BR>When cancer is diagnosed not to invade beyond the muscle layer by intraoperative ultrasonography, extended cholecystectomy (composed of resection of the gallbladder and wedgeshape resection of the liver and dissection of the cystic lymph node and the pericholedochal lymph nodes) should be performed. And if cancer is diagnosed to invade beyond the muscle layer, extended cholecystectomy combined with resection of the bile duct and regional lymph nodes (n<SUB>2</SUB>) should be performed. Segmentectomy (S<SUB>4</SUB>, S<SUB>5</SUB>) of the liver combined with pancreatoduodenectomy should be performed if lymphnodal (n<SUB>2</SUB>) and liver involvement is found at the operation.

Journal

  • Tando

    Tando 1(1), 61-68, 1987

    Japan Biliary Association

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