早期の上部胆管癌の1例

Early Cancer of the Upper Biliary Tract, Report of a Case

　胆管系悪性腫瘍の治療成績はPTC，ERCP，腹部血管造影，超音波，CTなどの検査法が進歩し，PTCドレナージによる術前の減黄処置がルーチンに行われるようになった今日でも，いまだ満足できるものではない．治療成績の向上には，当然のことながら早期発見，早期治療が最も重要であるが，早期の癌と言える症例は極めて少ない．最近7年間の当教室における胆管癌40例を胆道癌取扱い規約の胆管癌肉眼的進行度（Stage）分類で分けてみても，34例がStage Ⅲ以上で，Stage Ⅰは3例（7.5％）にすぎない．今回，比較的早期と思われる上部胆管癌の症例について報告する．

　A report is made of relatively early cancer of the upper biliary tract recently experienced by us.

　The patient, a 63-year-old woman, was admitted to the hospital because of a chief complaint of jaundice. Ultrasonic examination showed dilatation of the intrahepatic ducts and swollen gallbladder. PTC revealed a tumor-like shadow about 1.8 cm in diameter in the choledochus. Because of marked stenosis of the common hepatic duct, PTC drainage was performed. Brushing cytologic examination was positive for squamous cell carcinoma (Class V).

　Simultaneous celiac angiography with PTC did not disclose any cancer infiltration around the bile duct, so that cancer was diagnosed as resectable.

　Resection of the bile duct was done along with anastomosis of the hepatic ducts with the jejunum. Findings at operation were H₀, P₀, S₀, N₀, Hinf₀, Panc₀, D₀, G₀. Thus, cancer was in the Stage I, and curative resection was performed. In the resected specimen, the tumor was 1.0×1.0×0.7 cm, and nodular. Histologically it was tubular adenocarcinoma accompanied with squamous metaplasia. The depth of invasion reached only the fibroelastic layer and the serosa was not involved. Cancer invasion of the bile duct in the longitudinal direction was not seen: ly(-), v(-), n(-) and ne(-).

　One year after the surgical operation the patient is in good health with no signs of recurrence.

　No consensus regarding early cancer of the bile duct is obtained yet. We have come across three patients in the Stage I of bile duct cancer (according to General Rules for Surgical Studies on Cancer of Biliary Tract) in the resent seven years. The prognosis is good in all. At present, these cancer cases in Stage I can be included in the category of early bile duct cancer.