胆囊病変の粘膜像

Mucosal Pattern of Cholecystic Lesions

　近年，各種画像診断の進歩は目覚ましく，胆囊疾患に関してもリニア電子スキャンの普及により隆起性病変が数多く診断されるようになった．しかし，超音波（US）をはじめとした各種画像診断を駆使しても質的診断が困難なことが多く，更に一歩進んだ精密診断が必要である．われわれはUS映像下に胆囊を穿刺・ドレナージして，そのドレナージ・チューブからのバリウムとCO₂による胆囊二重造影法を，また，その瘻孔を拡張し瘻孔を通して胆囊内の内視鏡観察を行う経皮経肝胆囊鏡検査法（percutaneous transhepatic cholecystoscopy；PTCCS）を開発した¹⁾．

　本法の開発により従来X線的には充盈像や圧迫法でしか表現されることのなかった胆囊病変に関して，二重造影による粘膜像の変化の検討が可能となり，更に内視鏡による粘膜像の観察と，直視下生検などの病理学的診断がより確実に行えるようになった²⁾．本稿では症例を呈示すると共に，これまでに得られた2，3の知見について述べる．

　Mucosal pattern of normal gallbladder as well as various cholecystic lesions was studied by performing double contrast study from percutaneous transhepatic cholecystography and drainage (PTCCD), percutaneous transhepatic cholecystoscopy (PTCCS) and double contrast study of the resected specimens. The results obtained were as follows:

　The mucosal pattern of the normal gallbladder showed fine reticular pattern (FRP) by the double contrast study. The FRP was almost maintained in adenomyomatosis and cholesterosis. In cholesterosis, beaded reticular structure and minute protruded lesions were scattered and the PTCCS disclosed yellowish, speckled and reticular minute protrusions. In carcinoma of the gallbladder, FRP was destroyed and surface mucosa had coarse macronodular pattern and irregular barium flecks were noted indicating mucosal defects. PTCCS also demonstrated the similar findings of the double contrast study as well as scattered bleeding spots. By standing such mucosal pattern of the gallbladder, the early gallbladder cancer and range of cancer invasion could be diagnosed preoperatively.