十二指腸乳頭部腫瘍の肉眼所見

Macroscopic Classification of Carcinoma of the Papilla of Vater

要旨　胆道癌取扱い規約に基づく乳頭部癌の定義とその肉眼的形態分類法の考え方を紹介し，金沢大学第2外科学教室で経験した手術症例を中心にして十二指腸乳頭部腫瘍，なかんずく乳頭部癌の肉眼所見，進展様式や予後を検討した．胆道癌取扱い規約では，乳頭部の範囲を規定し，更に腫瘍の肉眼所見分類では，腫瘤型と潰瘍型とを規定して，そのほかに両者の混在型や特殊型をおいた．教室の拡大手術の方針で臨んだ1973年末以降の5年以上生存は8例69.8％に向上した．潰瘍型や潰瘍腫瘤型の進展度は腫瘤型に比べ膵浸潤，十二指腸浸潤，リンパ節転移，Stage因子ともに高く，その予後も悪かった．

　This paper addressed the definition and macroscopical classification of carcinoma of the papilla of Vater based on the general rules of clinical and pathological studies on carcinoma of the bile duct. Surgical cases experienced at our department were also examined with respect to macroscopical findings, forms of spread, and prognosis of this type of carcinoma. Extent of carcinoma of the papilla of Vater was determined based on the general rules, This type of carcinoma was classified macroscopically into the following types: tumor type, ulcer type, mixed type, and special type.

　Since 1973 when extensive surgery was introduced as a departmental principle, we experienced 8 patients with carcinoma of the papilla of Vater who survived more than 5 years (5-year survival rate,69.8％). Ulcer type, in particular, had the worst prognosis with exten-sive infiltration into the pancreas and the duodenum as well as lymphatic metastasis and high tumor stage.