先天性胆道拡張症に伴う胆管癌術後に発症した肝門部領域遺残胆管癌の1例  [in Japanese] A case of perihilar cholangiocarcinoma after surgery for distal cholangiocarcinoma with congenital biliary dilatation  [in Japanese]

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Abstract

<p>症例は52歳女性.42歳時にIV-A型の先天性胆道拡張症に合併した遠位胆管癌の診断で,肝外胆管切除,胆道再建が施行された(pT3N0M0,Stage III).術後3年目より,肝内胆管の拡張と繰り返す胆管炎が出現.術後5年目には,吻合部近傍の胆管壁肥厚と肝内結石も指摘されたが,治療の希望なく経過観察となっていた.術後10年目のCT検査にて肥厚した胆管壁の不整を指摘され,生検にて左優位の肝門部領域胆管癌と診断された.腫瘍は前後分岐部まで進展していたが,肝左3区域切除術を施行することで治癒切除を得ることが可能であった.今後分流手術の増加に伴い,長期合併症の一つである発癌症例も増えていくことが予想される.遺残胆管癌は切除に至らない症例も多く,本疾患を念頭においたフォローが重要となる.リスク症例に対する適切な対応並びに,手術のタイミングを逃さぬような治療戦略が必要と考えられた.</p>

<p>We herein report a case of perihilar cholangiocarcinoma detected 10 years after surgical treatment for distal cholangiocarcinoma with congenital biliary dilatation (CBD). A 52-year-old woman underwent extrahepatic bile duct resection for distal cholangiocarcinoma identified in CBD 10 years ago. Three years after the initial operation, she developed repetitive cholangitis due to stenosis of the cholangiojejunostomy. Additionally, 5 years after the initial operation, abdominal CT scan showed development of hepatolithiasis and hilar bile duct thickening. However, she refused further treatment and careful follow up was continued. In this year, CT scan revealed irregular thickening of the hilar bile duct. Biopsy from this region led to the definitive diagnosis of remnant hilar bile duct carcinoma. She underwent left hepatic trisectionectomy to achieve curative resection. Six months after the operation, she was still alive without recurrence.</p><p>Careful observation and adequate treatment is important during postoperative follow up for CBD.</p>

Journal

  • Tando

    Tando 30(4), 749-755, 2016

    Japan Biliary Association

Codes

  • NII Article ID (NAID)
    130005278022
  • Text Lang
    JPN
  • ISSN
    0914-0077
  • Data Source
    J-STAGE 
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