臨牀消化器内科 Vol.17 No.10(5-2)


特集名 膵・胆管合流異常 -- 最近の話題
題名 治療 (2) 胆管拡張を伴わない合流異常 b. 胆嚢摘出の是非と問題点
発刊年月 2002年 09月
著者 大内田 次郎 宮崎医科大学第一外科
著者 千々岩 一男 宮崎医科大学第一外科科
著者 園田 幸生 九州大学医学研究院臨床・腫瘍外科
著者 川本 雅彦 九州大学医学研究院臨床・腫瘍外科
著者 許斐 裕之 九州大学医学研究院臨床・腫瘍外科
著者 田中 雅夫 九州大学医学研究院臨床・腫瘍外科
【 要旨 】 胆管拡張を伴う膵・胆管合流異常(以下，拡張型合流異常)は，高頻度に胆道癌を合併することから分流手術が標準術式となっている．しかし，胆管拡張を伴わない合流異常(以下，非拡張型合流異常)の治療に関しては意見の一致がみられていない．非拡張型合流異常で問題になるのは，拡張型合流異常と比較して高率な胆嚢癌の合併である．自験146例のうち非拡張型合流異常は40例(27.4％)で，女性28例，男性12例，平均年齢は52.2歳(4～82歳)であった．この40例のうち予後が確認できた35例について検討した．35例のうち15例(42.9％)に胆嚢癌を，4例に膵癌を認め，胆管癌の合併は1例もなかった．癌非合併16例全例に胆嚢摘出術を施行したが，術後平均7年で胆管癌の発生は1例も認められなかった．胆嚢癌合併15例では8例(53.3％)がStageIVの進行癌で予後は不良であった．繰り返す胆管炎や膵炎が合併する場合を除き，非拡張型合流異常に対する治療としては胆嚢摘出術が長期予後および癌発生の予防の点から選択すべき治療法と考えられた．
Theme Recent Issues of Pancreaticobiliary Maljunction
Title Pancreaticobiliary Maljunction without Bile Duct Dilatation -- Cholecystectomy as a Treatment of Choice and Related Problems
Author Jiro Ohuchida Department of Surgery 1, Miyazaki Medical College
Author Kazuo Chijiiwa Department of Surgery 1, Miyazaki Medical College
Author Yukio Sonoda Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University
Author Masahiko Kawamoto Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University
Author Hiroyuki Konomi Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University
Author Masao Tanaka Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University
[ Summary ] Prophylactic resection of the gallbladder together with bile duct dilation, resulting in biliary diversion, is now the treatment of choice for pancreaticobiliary maljunction (PBMJ) with bile duct dilatation, because of the high risk of biliary tract carcinoma. However, methods of treatment for PBMJ without bile duct dilatation are still controversial. The incidence of gallbladder carcinoma in patients with PBMJ without bile duct dilatation is higher than that in those with bile duct dilatation. Of 146 patients with PBMJ, 4O (27.4%) patients (28 women and 12 men) did not receive bile duct dilatation, their mean age at diagnosis was 52.2 years old, ranging from 4 to 82. Follow ups were completed in 35 out of these 40 patients. Gallbladder carcinoma was found in 15 (42.9%) of the 35 patients, while none had bile duct carcinoma. After prophylactic cholecystectomy in the 16 patients with out gallbladder carcinoma, none developed bile duct carcinoma during the mean follow up period of 7 years after cholecystectomy. Eight of the 15 patients had stage IV gallbladder carcinoma and their prognosis was poor. Prophylactic cholecystectomy is the treatment of choice for patients with PBMJ without bileduct dilatation, and special attention to the possible presence of gallbladder carcinoma is mandatory for such patients.
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