特集名 | 胆道癌診断の現状と展望 -- 肝外胆管を中心に | |
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題名 | 胆道癌のハイリスク病変の診断と臨床的取り扱い | |
発刊年月 | 2003年 07月 | |
著者 | 西野 博一 | 東京慈恵会医科大学消化器・肝臓内科 |
【 要旨 】 | わが国において胆道癌が増加している.とくに女性では悪性新生物死亡者数の第6位を占めるに至っている.胆道癌のハイリスク病変として胆石症,膵・胆管合流異常,総胆管拡張症が発症因子であることが疫学的にも明らかである.診断の中心は画像診断であり,US,EUS,MRCP,ERCPなどにより胆管膵管の詳細な情報が必要である.臨床的な取り扱い上の重要な問題は,(1) 無症状胆石,(2) 胆管拡張を伴わない膵・胆管合流異常である.無症状胆石については年1~2回のUSによる経過観察でよいとの考え方が一般的となってきた.その一方,胆管拡張を伴わない膵・胆管合流異常は胆嚢摘出術には異論がないものの,肝外胆管切除術を加えるか否か意見の一致をみていない. 胆道癌の発症に関与する因子について,疫学的レビューをもとに,胆石症,膵・胆管合流異常,総胆管拡張症などの診断と臨床的取り扱いについて概説する. |
Theme | Diagnosis of Biliary Tract Cancer -- Present Status and Perspective | |
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Title | Diagnosis and Treatment of High-risk Biliary Tract Cancer Diseases | |
Author | Hirokazu Nishino | Division of Gastroenterology and Hepatology, Department of Internal Medicine, Jikei University, School of Medicine |
[ Summary ] | The number of bile duct cancer cases has increased in Japan since 1958. This was especially so in 2000, when the mortality rate was ranked sixth among malignant tumors in women. It is clear epidemiologically that cholelithiases, pancreaticobiliary maljunction, and choledochal cysts are high-risk factors associated with bile duct cancer. These clinical diagnoses are usually made by diagnostic imaging such as US, EUS, MRCP, ERCP. Clinical issues connected with high-risk disease are silent gallstones and pancreaticobiliary maljunction without common bile duct dilatation. In silent gallstone cases, follow up study by US is necessary one or two times in a year. In cases of pancreaticobiliary maljunction without dilatation of the common bile duct, a consensus of opinion is that a cholecystectomy should be performed, but the resection of the extrahepatic bile duct in preventing biliary carcinogenesis still remains controversial. The diagnosis and clinical issues related to high-risk diseases, such as cholelithiasis, pancreaticobiliary maljunction, choledochal cyst in bile duct cancer was summarized. |