当院における腹腔鏡下胆囊摘出術施行後に診断された胆囊癌の検討

Analysis of patients diagnosed with gallbladder cancer after laparoscopic cholecystectomy

◆要旨：【目的】当院における腹腔鏡下胆囊摘出術（LC）施行後に診断された潜在胆囊癌について，予測できる因子がないかを検討した．【対象および方法】2000年4月～2009年11月のLC施行655例について，各年代別に検討した．また，術後に判明した8例（1.2％）の胆囊癌についても検討した．【結果】胆囊癌の8例は男女比3：5，平均年齢69.7±12.6歳，平均手術時間109±53分で，m癌4例，mp癌1例，ss癌3例であった．ss癌は全例80歳代の症例であった．1例で再発・死亡していたが，全例追加根治術は行っていなかった．【結論】80歳以上の胆石，胆囊ポリープ症例については，術後胆囊癌と診断されることが他の年代と比較して多いことが示唆された．また，CTまたはPET-CTでリンパ節転移陰性と診断されれば，高齢者の潜在性ss胆囊癌において追加切除することなく経過観察できる可能性がある．

［Objective］Patients with subclinical gallbladder cancer diagnosed after laparoscopic cholecystectomy were analyzed for preoperative predictable factors. ［Subjects and Methods］The records of 655 patients who had undergone laparoscopic cholecystectomy between April 2000 and the end of November 2009 were analyzed. Eight patients who were found to have gallbladder cancer after surgery were also evaluated. ［Results］The mean age of the subjects was 69.7 ± 12.6 years （overall mean age, 57.3 ± 13.2 years）, with a male-to-female ratio of 3 : 5. The mean operative time was 109 ± 53 minutes. Histopathological examination showed m, mp, and ss cancers in 4, 1, and 3 patients, respectively. All 3 patients with ss cancer were in their 80s. One patient died of recurrence, and no patient underwent additional radical surgery. ［Conclusion］Patients older than 80 years with cholelithiasis or gallbladder polyps were more often diagnosed with gallbladder cancer after surgery than their younger counterparts. In addition, when CT or PET-CT examination does not show positive lymph-node metastasis in patients older than 80 years, it is important to consider the possibility of follow-up without any operation.