胆囊癌診断の現況と問題点―臨床総合診断の立場から

Present Status and Some Problems in Diagnosis of Gallbladder Carcinoma: From the Clinical Standpoint of All-round Diagnostic Imaging

要旨　過去8年間に当科および関連施設で経験した胆囊癌30例をもとに，胆囊癌診断の現況と問題点を指摘した．癌の深達度別，切除可能別に臨床症状の特徴を述べた．US，CT，胆道造影所見に基づいて，各々の型分類を行い進展度診断を行った．手術または剖検所見に基づいて最終診断がなされたがresectabilityと進展度診断との関連性について詳細に検討した．同時に将来の展望についても言及した．胆囊癌の早期診断のためには，2つのアプローチ，その1つはEUS，PTCCSなどの精密検査法の手技の確立と，ほかの1つは超音波集検体制の確立が必須であり，とりわけ後者の重要性を強調した．

　Based on our experience of 30 cases with gallbladder carcinoma in the past eight years, the present status of the art of diagnosis, and some problems in diagnosis of gallbladder carcinoma were pointed out.

　Clinical features were documented in terms of depth of cancerous invasion and resectability, respectively. Serum CEA levels were higher in advanced or unresected cases than in early or resected cases. Findings obtained from diagnostic imaging including US, CT and cholangiography were classified according to their respective patterns. Stages of disease-progress were decided according to those findings. Final assessment was carried out using operation or autopsy findings. Correlation between resectability and the stages of the cancer was analyzed and discussed in detail. Prospects for the future were also described. Establishment of two different systems should be mandatory in order to detect gallbladder carcinoma earlier. One would involve the use of further evaluation systems, e.g. EUS and PTCCS and so on. The other would be mass survey using ultrasonic technology. The importance of the early establishment of the latter mass-survey system was emphasized.