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◆要旨:血清CA19-9は膵胆道系の腫瘍マーカーとして用いられているが,胆囊炎などの良性疾患にて高値を示すことがある.患者は57歳,男性.壁肥厚を伴う胆囊炎でCA19-9は1,059U/mlと異常高値を示した.炎症反応の低下に伴いCA19-9は陰性化したため,胆囊癌は否定的で胆囊摘出術を腹腔鏡下に施行した.CA19-9が異常高値を示した胆囊炎の良悪性の鑑別点として,保存的治療前後でCA19-9値が低下する疾患は良性を考え,保存的療法で自覚,他覚所見が軽快した場合でも,高CA19-9血症が遷延する症例は悪性を考慮すべきあり,CA19-9が陰性化すれば,積極的に腹腔鏡下手術を選択すべきである.
The patient was a 57-year old male who was admitted to our hospital because of cholecystitis with irregular wall thickness. Laboratory data showed serum CA19-9 to be extremely high at 1,059U/ml. Gallbladder cancer complicated by cholecystitis was suspected and conservative therapy was started. Antibiotics reduced inflammation and serum CA19-9 levels also normalized to 6U/ml. Thus, we performed laparoscopic cholecystectomy. The serum CA19-9 level is decreased in benign disease after conservative treatment. When the serum CA19-9 level does not respond to conservative therapy, gallbladder cancer is more likely. In case malignancy can not be ruled out, careful evaluation is mandatory.
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