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Stomach and Intestine(Tokyo) Volume 18, Issue 10 （October 1983）

胃と腸 18巻10号（1983年10月発行）

Japanese English

今月の主題胆囊病変をめぐる最近の知見

主題

胆囊癌の早期診断 Early Diagnosis of Carcinoma of the Gallbladder 富士匡 ¹ , 天野秀雄 ¹ , 相部剛 ¹ , 衣川皇博 ¹ , 浅上文雄 ¹ , 播磨一雄 ¹ , 竹本忠良 ¹ T. Fuji ¹ , H. Amano ¹ , T. Aiba ¹ , K. Kinukawa ¹ , H. Asagami ¹ , K. Harima ¹ , T. Takemoto ¹ ¹山口大学医学部第1内科 ¹The First Department of Internal Medicine, Yamaguchi University, School of Medicine pp.1063-1068

発行日 1983年10月25日 Published Date 1983/10/25

DOI https://doi.org/10.11477/mf.1403109301

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Abstract 文献概要
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　最近数年の間に，早期癌，進行癌を問わず，胆囊癌の術前診断は大変容易となってきている．この理由は，画像診断法の発展によるところが大であることは言うまでもなく，特に最近急速な勢いで普及してきた超音波の画像の解像力の向上と相まって，本法が最もアプローチしやすい腹腔臓器の1つが胆囊であるからにほかならない．

　したがって，これまで胆囊病変のルーチンの検査法としての排泄性胆道造影法はもちろんのこと，精密検査法として用いられてきたERCPやPTCでさえも，胆囊病変の診断に限って言えば，やや影が薄くなってきた感じがする．その大きな理由として，胆道造影法は造影できた画像の断端像からの診断であるのに対して，超音波検査やCTは病変そのものの直接的な描出法であることが大きな持ち味となっていることが挙げられる．

　A diagnosis of carcinoma of the gallbladder, including early carcinoma, has become easier. This is due mainly to rapidly spreading ERCP and ultrasonographic study. Concerning the diagnosis of gallbladder lesions, improved resolving power of the ultrasonography made even diagnostic role of the ERCP less.

　We defined the early carcinoma of the gallbladder as follows: The lesion is limited to the gallbladder and its depth is within mucosa or lamina propria. With this criterion, we studied the early diagnostic method of carcinoma of the gallbladder through diagnostic processes of our cases.

　Among our seven cases of early carcinoma of the gallbladder, one case was found during an operation of gastric cancer, and three cases were misdiagnosed as cholelithlasis by diagnostic modalities, which were performed for abdominal pain and elevated biliary tract enzymes, and found to be early carcinoma postoperatively. Analyzing these cases and comparing ultrasonographic and ERCP's findings to the resected specimens, we have been able to suspect the early carcinoma of the gallbladder preoperatively and have performed extended cholecystectomy for such cases in recent three years. Combining ultrasonographic study with ERCP, we could obtain detailed informations of surface character of the early carcinoma of the gallbladder.

　However, small lesion which is less than 1 cm in size, is quite difficult not only for their differential diagnosis between benign and malignant but also for determination of their management. Furthermore, a diagnosis of Ⅱb-type-like early carcinoma of the gallbladder has not been defined and further study should he encouraged in this field.