黄疸を主訴として発見された早期下部胆管癌の1例

Early Cancer of the Distal Bile Duct, Report of a Case

　早期胆管癌の定義はいまだ確立されたものはないが，第15回胆道疾患研究会において集計された37例につき検討し，角田ら⁴⁾は現在のところ癌が胆管壁内に限局し，リンパ節転移のないことを挙げている．胆道系の癌は一般に，症状発現の時期には既に進行した症例が多いため，早期癌は極めてまれであり，永光の報告¹⁾でも1970年までの全国集計では5例にすぎなかった．しかしながら最近ではERCPおよびPTCに加え，X線CT，更に腹部超音波検査による映像診断の進歩により切除可能で，かつ根治性も期待しうる症例が増加しつつある．今回私どもは黄疸を主訴として来院したが，切除標本では0.5×0.8×0.6cm大の総胆管末端の早期癌であった1例を経験したので報告する．

　A report is made of resected early cancer of the distal bile duct (terminal end of the common bile duct) suspected due to the presence of the chief symptom of icterus and diagnosed as such by clinical investigations. Abdominal US examination showed dilatation of the choledochus and intrahepatic ducts unaccompanied by stone echo. PTC made is possible for us to arrive at a diagnosis of biliary tract occlusion due to cancer of the distal bile duct. Direct findings of a tumor were not obtained by CT, angiography or hypotonic duodenography. We suspected then that the lesion, if any, must be relatively small, unaccompanied by infiltration into the pancreatic head or other adjacent tissue. These findings were effective for us to determine the indication for a surgical operation, affording us further information about the vascular system at the time of the operation. This was also effective for determining the extent of the resection.