ESUによる胆管癌の進展度診断

Evaluation of the Extent of Bile Duct Cancer by Endoscopic Ultrasonography

要旨　超音波内視鏡（EUS）による胆管癌の進展度の診断能を検討するために，20例の肝外胆管癌（Bm癌5例，Bi癌15例）のEUS像と病理組織像とを比較検討した．EUSの腫瘍描出率は17/20例（85％）であった．肉眼型別では，隆起型が16/17例（94.1％），平坦型が1/3例（33.3％）の描出率であった．腫瘍エコー像は17例中16例でやや低エコーの腫瘤像，胆管壁肥厚像を，1例でやや高エコーの腫瘤像を示した．EUSにより，上皮内進展は9/17例（52.9％）に描出された．EUSによる深達度診断の正診率は14/17例（82.4％）であった．また，膵浸潤は8/13例（61.5％），十二指腸浸潤は7/10例（70％），門脈浸潤は14/15例（93.3％）の正診率であった．

　To evaluate the diagnostic efficacy of EUS for bile duct cancer, twenty patients with carcinoma of the middle (5cases) and lower (15cases) bile duct, which had undergone endoscopic ultrasonography (EUS) preoperatively, were reviewed.

　EUS images were compared with the histological findings of the surgical materials in each case.

　EUS showed a hyperechoic lesion in one case and slightly hypoechoic tumors or thickening of the bile duct wall in 17 0f the 20 cases, a total detection rate of 85%. Elevated-type carcinomas (94.1%) were more frequently visualized by EUS than flat-type carcinomas (33.3%).

　Although intraepithelial spreading of the carcinomas was present histologically in all the cases examined, it was depicted by EUS in only 9 of the 17 cases (52.9%). Diagnostic accuracy rates of EUS for invasion of the surrounding tissue by the carcinoma were as follows: the subserosa, 14/17 cases (82.4%); the pancreas, 8/13 (61.5%); the duodenal wall, 7/10 (70%); the portal vein, 14/15 (93.3%).

　Our conclusion was that EUS is a useful procedure for the diagnosis of the extent of carcinoma of the bile duct.