剖検所見からみた膵癌診断・治療上の問題点―進展様式・切除後再発形式・術中照射の効果に対する病理学的検討

Problems in Diagnosis and Treatment of Pancreatic Cancer as Seen in the Au-topsy Findings: Pathological study of the mode of cancer spread, postoperative recurrence and intraoperative radiotherapy cases

要旨　膵癌剖検例68例を対象に，進展様式，術後再発形式，術中照射例の病理学的検索を行い以下の結論を得た．（1）膵癌のその局在から，鉤部，頭部，体部，尾部の4部に分けて検討することにより，それぞれの部位に発生した癌の進展様式，更には臨床症状に差がみられ，特に鉤部癌は頭部癌から独立させて扱うべきと考える．（2）術後再発例，術中照射例などと非手術例，非照射例の癌の進展様式には差がなく，特に手術時の摘出標本の検索でew（－）と判定された例でも全例，後腹膜再発をみたことは，手術的治療の困難性の一面を示している．（3）術中照射後剖検例の検索から，癌細胞は照射野の辺縁に残存？（再増殖?）することが示唆された．このことは今後の術中照射の在り方を検討するうえで示唆に富んだ所見と考える．

　The results obtained from a pathological study of the cancer spread, postoperative recurrence and intraoperative radiotherapy in 68 autopsy cases of pancreatic cancer were as follows :

　1) The study of pancreatic cancer was conducted by classifying the cases according to the location of the cancer; uncus, head, body and tail. Difference was seen in the mode of cancer spread and also in the clinical symptoms among the pancreatic cancers in each location. Especially, it was maintained that cancer in the uncus should be treated independently from the cancer in the head.

　2) There was no difference in the mode of cancer spread between postoperative recurrence or intraoperative radiotherapy cases and non-operated or nonintraoperative radiotherapy cases. Moreover, it suggested one side of difficulty of the surgical treatment, that is, all cases considered curative operation were performed through histological study of the resected specimen at operation have had retroperitoneal recurrence.

　3) By histological study of autopsy cases of intraoperative radiotherapy, it was suggested that cancer cells remained or regrew in the periphery of the radiotherapy field, which is a meaningful finding for evaluating intraoperative radiotherapy in the future.