早期胆嚢癌の精密検査―Angio，CT，X線検査などの画像診断

Gallbladder Carcinoma-Diagnosis, Treatment and Clinico-pathological Study of Resectable Tumor

要旨　最近の14年間にUS，CT，直接胆道造影および血管造影を行って診断し，手術または剖検により病理組織学的に確診された胆嚢癌62例のうち，切除36例を対象にその臨床病理学的事項，治療成績および診断的事項を検討した．肉眼的分類では隆起・腫瘤型と表層・浸潤型が各々ほぼ半数を占め，いずれも胆石症，または膵胆管合流異常を合併する頻度が高い．治療成績の検討からm癌，pm癌，ss-RAS癌を早期癌と定義するのが妥当である．切除例全般の各検査法による診断成績を比較すると血管造影の成績が優れているが，早期癌では隆起型癌・無石例でのUSの診断能を除いていずれも悪い．今後，胆道二重造影による微細診断の積極的な利用が望ましい．

　From 1972 to 1985, we experienced 62 patients with proven gallbladder carcinoma with male to female ratio of 1 : 3.769 and average of 64.4, In this study, relevant issues in diagnosis, treatment and clinicopathological aspect of 36 patients with resectable gallbladder tumor were reviewed. Out of 62, 36 patients were examined by US, CT, direct cholangiography via PTC or ERCP, and angiography.

　Macroscopic findings showed protruding tumor in 14 patients (39%), sizable mass in six patients (17%), flat type tumor in three patients (8%) and invasive type tumor in 13 patients (36%). Twenty patients (56%) had accompanied gallbladder stone and four (11%), an union of pancreatic duct and common bile duct in the pancreas. Pathological study revealed adenocarcinoma in 35 patients and adenoacanthoma in one patient, Five-year cummulative survival rate of seven patients with tumors of earlier stage, i.e., one confined to mucosal layer, proper muscle layer and Rokitansky-Aschoff sinus in subserosal layer, was 100%, whereas three-year cumulative survival rate of other 29 patients with serosal invasion was only 5%. Angiography was the most reliable modality in the diagnosis of resectable tumor. But none of the modaiities, US, CT, direct cholangiography and angiography was helpful for the diagnosis of tumors in ealier stage. Considering these results, we should develop a technique like Endoscopic Retrograde Biliary Double-contrast Radiography (ERBDR) to demonstrate the gallbladder mucosa in more detail.