新しい診断法による胆囊癌の進展度診断

Diagnostic Imaging System for Precise Diagnosis of Spread of Carcinoma of the Gallbladder with New Procedures; EUS, PTCCS and PTDCC

要旨　63例の胆囊癌手術例の検討から，胆囊癌の進展様式のうち，診断，治療上問題となる点は，RASからの深部浸潤，ss癌での遠隔リンパ節転移，および表層拡大性の粘膜内進展，特に胆管への粘膜進展であることがわかった．これらを加味して，適切な進展度診断がなされ，治療へ反映される必要がある．われわれはUSにて進行癌と判断されれば，他の画像診断により，B，N，H因子などについて総合診断を行い，早期癌あるいは早期癌類似のUS像であれば，EUSにより壁深達度診断を，PTCCSにより組織診断を，PTCCSおよびPTDCCにより粘膜面での拡がり診断を行い，正確な進展度診断を目指している．これらの新しい診断法を用いた胆囊癌の進展度診断における診断体系について検討した．

　Sixty-three cases of carcinoma of the gallbladder treated at our hospital since 1979 to 1986 were reviewed with special attention given to the way the carcinomas spread. Some aspects that must be noted at diagnosis and treatment of carcinoma of the gallbladder were clarified e.g., invasion of the deep layer along to the Rokitansky-Aschoff sinus, lymph node metastasis in a case with involvement of subserosal layer and mucosal, superficial extention, and, especially, intraductal extension to the bile duct. At diagnosis of carcinoma of the gallbladder, precise knowledge concerning the spread of the carcinoma is necessary for adequate treatment and good prognosis. In this report, we presented a new, total system of diagnostic imaging with new procedures such as endoscopic ultrasonography (EUS), percutaneous transhepatic cholecystoscopy (PTCCS) and percutaneous transhepatic double contrast study (PTDCC). Ultrasonography (US) was very useful for detection of carcinoma of the gallbladder. In a case diagnosed as advanced cancer with US, further examinations using such methods as computed tomography, ERCP, PTC and angiography were performed for the detection of involvement of lymph nodes, bile duct, or liver, etc. In a doubtful case of carcinoma, or suspected case of early carcinoma, EUS was recommended for diagnosis of carcinoma or for gausing the depth of cancer invasion. PTCCS was useful for histological diagnosis in a case where it was hard to make a differential diagnosis between cancer and other disease. PTCCS and PTDCC are useful for diagnosis of mucosal extention of carcinoma. Precise diagnosis of cancer spread can be done with these new techniques developed by us.