経皮経肝胆道鏡直視下生検により術前に左肝管まで浸潤していることを診断した総胆管癌の1症例

Common Bile Duct Cancer, Report of a Case: Its extent was diagnosed before operation by percutaneous transhepatic cholangioscopic biopsy

　胆管癌症例に対する診断法の進歩は著しいものがある．しかし，術前に病理組織学的診断，およびその腫瘍の浸潤範囲を知ることは困難であることが多い．われわれは，胆管癌の診断をより確実に行うために二村ら¹⁾の報告したごとく，1975年以来，経皮経肝胆道生検（PTCB）を行い，更に1977年以来，経皮経肝胆道鏡検査（PTCS）を行ってきた．また1979年より，経皮経肝胆道鏡直視下生検に成功した²⁾．このたび同検査により，左肝管にまで広範囲に浸潤した総胆管癌を術前に診断した1症例を経験したので報告する．

　Our experience of percutaneous transhepatic cholangio-biopsy(PTCB)to diagnose obstructive jaundice started in 1975. Since then the advanced techniques have been developed such as percutaneous transhepatic cholangio-scopy in 1977 and cholangioscopic biopsy in 1979.

　We report here a case of common bile duct carcinoma, that developed in the common and left hepatic ducts, and that was diagnosed by means of cholangioscopic biopsy before an operation.

　The patient was a 55 years old woman who was admitted to the Yokoyama Hospital with a complaint of jaundice in November 1979. The echogram and computed tomogram indicated dilatation of the gallbladder and bile duct. Percutaneous transhepatic cholangio-drainage (PTCD) was performed immediately. Complete obstruction of the common bile duct in the pancreas was found in the cholangiogram and a common bile duct carcinoma was suspected at that time. PTCS with the use of a fiberscope, 3.2mm in diameter, was performed on the 14th day after PTCD. The lesion of the tumor was found in the common hepatic duct. With the use of a bronchofiberscope (BF-4B2), 4.9m in diameter, cholangioscopic biopsy was done on the common bile duct, common hepatic duct, and left hepatic duct. Moderately defferentiated adenocarcinoma was found in each specimen. As a result, it was shown before the operation that the common bile duct carcinoma had developed diffusely to the left hepatic duct. ancreatoduodenectomy and the resection of the left and right hepatic ducts were performed. Histopathological examination proved that the carcinoma inwaded into the pancreas, the gallbladder, left and right hepatic ducts.

　Cholangioswpic biopsy is a reliable procedure in order to diagnose bile duct carcinoma and its extent before operation as shown in this patient.