臨床経過を観察し癌の進展度を確診できた胆囊癌の1例

Diagnostic Imaging in the Staging of Carcinoma of the Gallbladder, Report of a Case

要旨　約1年間にわたり臨床経過を観察し，癌の進展度を確診できた胆囊癌の1例を報告した．また胆囊癌自験40例について，US，CT，直接胆道造影，血管造影の各種検査法の癌進展度診断能を検討した．各種画像診断の組み合わせによって胆囊癌の進展度を診断できるようになった．胆囊癌患者の延命を図るためには，進展度に応じた適切な治療法を選択すべきであり，治療前の癌進展範囲に関する正確な診断が求められる．

　Preoperative staging of carcinoma of the gallbladder is clinically important in the selection of treatment. Staging of advanced carcinoma (Stage Ⅲ and Ⅳ) can be assessed by ultrasonography (US) and computed tomograpy (CT). Massive invasion of the liver, lymph node metastasis and spread to the neighboring organs are readily demonstrated. However, angiograpy is required for the assessment of Stage Ⅰ and Ⅱ carcinoma of the gallbladder. Serosal invasion and resectable invasion of the liver bed are difficult to diagnose with US and CT. These findings can be demonstrated by subselective angiogram. It was possible to differentiate Stage Ⅰ and Ⅱ carcinoma of the gallbladder from Stage Ⅲ and Ⅳ carcinoma of the gallbladder by diagnostic imaging.