原発性胆囊管癌の1治験例

Primary Carcinoma Arising from Cystic Duct, Report of a Case

要旨　極めてまれな原発性胆囊管癌の症例を経験した．患者は34歳男性，右季肋部痛・発熱を主訴とし，経皮経肝的胆囊造影にて胆囊管の不整狭窄像を認めたため胆囊管癌の術前診断にて開腹し，胆囊摘出術，胆管合併切除術を施行した．摘出標本の病理組織学的検査にて胆囊管に限局した管状腺癌を認め原発性胆囊管癌と診断され，また，肝十二指腸間膜内の神経周囲侵襲が高度に認められた．治癒切除と判断したが，手術5年後に再発死亡した．本症例の概要を紹介すると共に，胆囊癌の進展様式としての胆管側浸潤に対する外科的治療の問題点について述べた．

　We encountered a very rare case with primary carcinoma of the cystic duct. The case was that of a 34 year-old man complaining of right hypochondralgia and fever. Percutaneous transhepatic cholecystography disclosed irregular stenotic findings in the cystic duct. A laparotomy was performed under the preoperative diagnosis of carcinoma of the cystic duct and the operative methods employed were cholecystectomy combined with resection of the extrahepatic bile duct. Pathological examination of the resected specimen showed tubular adenocarcinoma localized within the cystic duct and the diagnosis was primary carcinoma of the cystic duct. However, perineural invasion of the hepato-duodenal mesentery was very marked. Although the operation was considered as a curative resection, the patient died five years after the operation. This case was described in detail and controversial surgical treatment for invasion of carcinoma into the bile duct extending from the carcinoma of the gallbladder was discussed.