胆道系の早期癌

A Study on Early Cancer of the Gallbladder and the Bile Duct

はじめに

　胆道の癌は予後の極めて悪い疾患であり，術後5年生存例は非常に少ない．従って，早期癌の定義を決めようとしても，討議の資料となるべき症例が少ないために，胆道系では早期癌の定義すら決定されていない．第56回日本消化器病学会総会に於て胃以外の消化器の早期癌がパネルに取上げられ，筆者は胆道疾患研究会の会員として胆道系の早期癌について報告するよう求められたのであるが，以上のような事情から一応術後5年以上生存したものをもってこれに当てることとした．症例の収集は胆道疾患研究会会員の協力によって行なわれ，調査対象はほぼ全国にまたがり，127施設である．なお，本論文では胆道を胆嚢および肝外胆管に限定し，十二指腸乳頭癌は除外した．十二指腸乳頭部癌は癌の発生母地が胆管上皮であるのか，膵臓起源であるのかあるいは，十二指腸粘膜に由来するのか明らかにし得ないものが多く，また解剖学的，組織学的にも胆嚢および胆管のもつ特殊性と異なるところがあるので，これを胆道系の癌から除外した．

　予期したように5年生存例は極めて少なく，収集し得た症例は胆嚢癌14例，胆管癌5例のみである．

　胆道系の癌のうち，胆嚢癌と胆管癌とでは癌の進展の様態，症候の現われ方，胆石との関係，また診断法および手術術式においてもそれぞれ異なるものがあるので別々に述べる．

　There is as yet no definition of early cancer of the gallbladder and the bile duct, so we have collected only those cases that had no signs of cancer relapse five years after surgical operation. From 127 institutions in Japan we have been able to gather only 14 cases of cancer of the gallbladder belonging to such category.

　Two of 14 patients of the gallbladder cancer were of advanced cancer, but one of them was alive fifteen years after operation and the other is now healthy after 13 years. Early cancer of the gallbladder appears to be related to older age and longstanding chronic gallbladder diseases. Seven patients were more than 50 years of age. Sex incidence also tend to resemble that found in advanced cancer in that 71 per cent were women. Except 2 advanced cancers, 10 of 12 patients were operated on with unquestionable clinical diagnosis of cholecystitis with or without calculi. Only in 2 of 12 patients were tumors seen as polyps in cholecystograms. Eight of 12 patients were associated with calculi. As for the site of early cancer of the gallbladder, 4 were in the fundus, 4 in the body and 4 in the pouch, all smaller than the thumb-tip. In the pathological findings, nodal involvement was found in 9 of 12 patients, and in 3 was plain or ulcerative. Adenocarcinoma was found in all. In almost all of them it remained in the muscle layer or in situ, not extending into the subserosa. There was no metastasis to lymph node. Cancer of the gallbladder, once the subserosa is infiltrated, shows high tendency to spread to other organs via vascular and lymphatic channels.

　Early cancer of the bile duct was seen in 5 patients. One of them is alive 5 years and another 9 years after surgical operation. One cancer was found in the beginning of the choledochus and the other 4 in the pancreas head. All were adenocarcinomas.