肝内直接浸潤を伴った進行胆囊癌の2例

Gallbladder Carcinoma with Direct Hepatic Invasion, Report of Two Cases

要旨　肝内直接浸潤（Hinf）を伴った進行胆囊癌2例の切除例を報告した．Hinfの有無は2例とも血管造影で判定できた．その浸潤範囲は1例ではCTと超音波断層（US）で，他の1例はCTと経皮胆管造影（PTC）で判定したが，後者では肝内に囊腫様病変が多数併存していたため，Hinfの範囲に関するCTの読影に誤りを来した．前者は肝部分切除で，後者は右3区域切除を行うことにより根治的に切除しえた．

　〔Case 1〕 A 67 year-old woman was admitted with the complaint of epigastric pain and palpable right upper quadrant mass. Ultrasonography showed thickened gallbladder wall and a large mass with irregular echoes in the liver. Computed tomography (CT) revealed a large low density area which was enhanced after contrast infusion. Celiac arteriography revealed luminal irregularity and stretching of the cystic branches. Cholecystectomy with partial hepatic resection and node dissection were performed. Four years and two months after surgery, she is still free from the disease.

　〔Case 2〕 A 72 year-old man was admitted on account of painless jaundice. Percutaneous transhepatic cholangiogram (PTC) showed dilated intrahepatic bile ducts with marked stenosis at the hepatic hilus. For technical reasons, the gallbladder was difficult to visualize by ultrasonography. CT showed a slight thickened wall of the gallbladder and multiple low density areas in the liver. The cystic artery was not delineated and encasement of the hepatic branches was noted by selective hepatic arteriography. These findings in CT and arteriography suggested cholangiocarcinoma of the liver or gallbladder carcinoma with direct hepatic invasion. At laparotomy, examination of frozen section of the tumor showed gallbladder carcinoma with hepatic invasion. Right trisegmentectomy of the liver with resection of the extrahepatic duct was performed. One year and six months after successful surgery, the patient is doing well.