2年4か月間臨床経過を観察された胆囊癌の1例

Gallbladder Cancer Followed-up for Twenty-eight Months, Report of a Case

要旨　患者は33歳，男性．1980年12月，心窩部痛を主訴に当科受診，腹部超音波検査（US）にて胆囊ポリープと診断した．精査を勧めたが拒否したため，以後，外来にて経過観察を行った．1981年6月，1982年3月，USにて胆囊ポリープの増大を認めたが，再び精査を拒否．1982年10月，心窩部痛増強したため入院した．経皮経肝胆囊ドレナージ（PTCCD），経皮経肝胆囊内視鏡検査（PTCCS）を実施し，結節浸潤型の進行胆囊癌と診断，胆囊摘出，肝内側区域下部・前下区域合併切除術を施行した．切除標本の病理組織学的検索では，深達度ssの結節浸潤型胆囊癌で，s₀h₀hinf₀b₀p₀n₀ Stage Ⅰであった．

　In December 1980, a 33 year-old man visited our hospital with complaints of epigastric pain. Through ultrasonography, a diagnosis of gallbladder polyps was able to be made (Fig. 1). We recommended close observation, but he rejected to cooperate. He agreed to be followed-up only as an outpatient.

　In June 1981 and March 1982, ultrasonography revealed growth of the polyps (Fig. 2, 3). In October 1982, he was admitted to our hospital for close examination because of severe epigastric pain.

　By percutaneous transhepatic cholecystodrainage (PTCCD) and percutaneous transhepatic cholecystoscopy (PTCCS) the polyps were diagnosed as advanced gallbladder cancer (Fig. 5, 7, 8), so cholecystectomy and hepatic lobectomy were carried out. Histologically the cancer had invaded to the subserosa of the gallbladder wall (Fig. 9～11).