Abstract
症例は67歳,男性.心窩部痛を認め,加療目的に当科受診となった.画像検査で肝内胆管・総胆管の拡張と胆嚢管の壁肥厚を認め,ERCPにて乳頭より多量のゼリー状緑色粘液の排出が確認された.さらに,経口胆道内視鏡にて胆嚢管口に緑色粘液を認め,胆汁細胞診はClass V (adenocarcinoma)であった.胆管の粘膜表面には明らかな異常所見を認めなかった.以上より粘液産生胆嚢管癌と診断し,肝床部分切除を伴う胆嚢摘出術・肝外胆管切除・D2リンパ節郭清・胆管空腸吻合術を施行した.胆嚢管に全周性の境界不明瞭で表面乳頭状の璧肥厚所見を認め,胆嚢内は粘稠な緑色ゼリー状粘液で充満していた.組織学的には深達度はssの高分化型腺癌であり,リンパ節転移は認めず,stage IIであった.今回,われわれは粘液産生胆嚢管癌を,経口胆道内視鏡にて術前診断しえた1例を経験したので,報告する.
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More From: Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)
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