早期胆嚢癌の精密検査―ERCPを中心に

Clinical Evaluation of ERCP in the Diagnosis of Early Cancer of the Gallbladder

要旨　近年の画像診断の進歩により早期の胆嚢癌は多く診断されるようになってきたが，ERCPによる診断能はあまり高くはない．われわれの施設では，過去10年間に20例の胆嚢癌が切除されたが，そのうち早期胆嚢癌は4例であった．ERCPで診断可能な例は1例で他の3例は胆石が合併しており，ERCPの所見は胆嚢不影で質的診断は全く不可能な症例であった．切除された進行癌でもERCPで診断可能であった例はわずかに3例，結石のみ造影された例が2例であった．結論としては隆起性の胆嚢病変は撮影方法に工夫を行えば診断可能であるが，表面型の胆嚢癌は従来の方法でのERCPでは診断困難である．

In the past ten years, four cases of early cancer of the gallbladder were diagnosed. ERCP was unable to reveal three of these four cases because of obstruction of the cystic duct by the existence of gallstones Only in one case was the gallbladder effectively visualized by ERCP. Filling defect was observed. Of 16 cases of resected gallbladder cancer cases, three cases were diagnosed by ERCP. In three cases of the 16 resected cases, gallstones were visualized but cancer were not diagnosed. In ten cases, the gallbladder was not able to be visualized at all.

As a clinical evaluation, it can be said that ERCP plays a diagnostic role by visualization of the fine structure of the surface of the elevated cancer.

On the other hand, the biggest disadvantage of ERCP in the diagnosis of gallbladder cancer is that the gallbladder was hardly able to be visualized in cases where gallstones were present or in cases with cystic duct obstruction. In cases with flat type of gallbladder cancer, ERCP was nearly useless for diagnosis.

　In conclusion, it should be said that ERCP is not so important in the diagnosis of early cancer of the gallbladder, but is important to check the situation of the neighbouring organs, such as the common bile duct.