| 特集名 | 鏡視下手術時代の消化器手術適応 | |
|---|---|---|
| 題名 | 胆道 (2) 胆嚢隆起性病変 | |
| 発刊年月 | 2008年 04月 | |
| 著者 | 平井 一郎 | 山形大学医学部消化器・一般外科 |
| 著者 | 森谷 敏幸 | 山形大学医学部消化器・一般外科 |
| 著者 | 渡邊 利広 | 山形大学医学部消化器・一般外科 |
| 著者 | 菅原 秀一郎 | 山形大学医学部消化器・一般外科 |
| 著者 | 木村 理 | 山形大学医学部消化器・一般外科 |
| 【 要旨 】 | 近年，胆嚢疾患に対して腹腔鏡下胆嚢摘出術がゴールドスタンダードな手術となっている．しかし，その1 %以下に胆嚢癌が認められており，術中胆汁漏出によるポート部再発や癌性腹膜炎が問題となっている． 胆嚢隆起性病変の多くはコレステロールポリープで茎が細く，高エコー，桑実状，多発性である．広基性，低 - 等エコー，表面不整な10 mm以上の病変に癌が多い．腫瘍径の増大が明らかなものも癌を疑い手術適応とする． 診断法にはCT, MRI, Doppler USなどがあるが，深達度診断まで可能なEUSがもっとも重要と考えられる． 術中，術後にmp, ss以深の胆嚢癌と判明した場合は肝部分切除，リンパ節郭清を追加する． 胆嚢隆起性病変に対する手術適応は広基性か有茎性か，大きさ，表面の性状，エコー輝度などを詳細に検討して決定する． |
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| Theme | Surgical Indication for Gastrointestinal Diseases in the Era of Endoscopic Surgery | |
|---|---|---|
| Title | Elevated Lesions in the Gallbladder | |
| Author | Ichiro Hirai | Department of Gastroenterological and General Surgery, Yamagata University School of Medicine |
| Author | Toshiyuki Moriya | Department of Gastroenterological and General Surgery, Yamagata University School of Medicine |
| Author | Toshihiro Watanabe | Department of Gastroenterological and General Surgery, Yamagata University School of Medicine |
| Author | Shuichiro Sugawara | Department of Gastroenterological and General Surgery, Yamagata University School of Medicine |
| Author | Wataru Kimura | Department of Gastroenterological and General Surgery, Yamagata University School of Medicine |
| [ Summary ] | Laparoscopic cholecystectomy has become the gold standard operation for gallbladder diseases. Gallbladder cancer occurrs in approximately 1 % of patients treated with laparoscopic cholecystectomy. Port site recurrence and dissemination are serious complications. The most frequently observed elevated lesion in the gallbladder is cholesterol polyps, which display a thin steal, hyperechoic, mulberry like surfaces, and occur in multiples. Tumors with sessile, low-isoechoic, irregular surfaces and greater than 10 mm in diameter should be considered to be gallbladder cancer. Operations way also be performed for tumors which are larger. There are many diagnostic options for gallbladder tumors, such as CTs, MRIs and Doppler US. However, EUS is considered to be the most reliable diagnostic technique for diagnosis of malignancies. When advanced gallbladder cancer is revealed during or after laparoscopic cholecystectomy, partial resection of the liver and lymph node dissection should also be performed. Preoperative meticulous diagnosis, due to conditions such as wide or thin peduncles, size, surface shape and echo levels are important for treating elevated gallbladder lesions. |
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