Koichi Kubota

INVESTIGATION OF THE GALLBLADDER CARCINOMA ACCOMPANIED WITH ACUTE CHOLECYSTITIS

An investigation was made on the causes and diagnosis in 5 cases of gallbladder carcinoma ac-companied with acute cholecystitis which had different pathosis and causes each other. One case was of acute cholecystitis caused by calculus impaction accompanied with abiogenetic carcinoma without any relationship between the carcinoma and cholecystitis. Of the remaining 4 cases of cholecystitis caused by a gallbladder carcinoma, one case developed acute cholecystitis with an impacted calculus which was accompanied with edema in the neck due to wide-spreading invasion of carcinoma in the main gallbladder; another one case developed acute cholecystitis with occlusion of the cystic duct due to a gallbladder carcinoma arising in the duct; and two cases developed acute cholecystitis, because tumor necrosis tissue due to a gallbladder carcinoma fully occupied the lumen of the gallbladder. The pathosis and causes of cholecystitis were different from each other as mentioned above, and unclear images due to inflammation sometimes disturbed us in making the preoperative diagnosis. Accordingly, it is necessary to carry out careful observation and inspection always with attention to possible complication of carcinoma, even if the image diagnoses exhibit acute cholecystitis.

STUDY OF COMPLICATIONS AFTER RESECTION OF BILIARY TRACT CANCER

Seventy-two patients who underwent resection of biliary tract cancer in the department were examined for early and late postoperative complications. They included 32 patients with gallbladder cancer, 28 with bile duct cancer and 12 with papillary cancer, treated by pancreatoduodenectomy (26 cases), combined hepatectomy and pancreatectomy (13 cases), two or more hepatic segmentectomy (10 cases) and other methods (23 cases). Early postoperative complications, occurring within two months after surgery, were found in 23 (31.9%) patients, and 9 (12.5%) died consequently. Hyperbilirubinemia (10 cases), sutural insufficiency (8 cases) and after-bleeding (6 cases) were conspicuous, showing high incidences of 60.0% and 53.8% after two or more hepatic segmentectomy and after combined hepatectomy and pancreatectomy, respectively. Late complications occurred in 7 (46.7%) of 15 patients who had no recurrence for 2 or more years after surgery, and 4 (26.7%) died. The four patients died had undergone pancreatoduodenectomy, their complications being nutritional disturbance in two and chronic hepatic disorder in other two. Severe complications were found only after pancreatoduodenectomy, other surgical techniques being associated with mild complications. Considering the fact that 5 deaths from cancer occurred two or more years after surgery, total body management of patients long after pancreatoduodenectomy is important. In selecting the method of surgery for biliary tract cancer, due attention should be paid not only to the radicality of the operation but also to possible postoperative complications.

A Patient with Advanced Gallbladder Cancer Aliving 5 Years after Simultaneous Resection of the Liver and Pancreas.

近年, 進行胆嚢癌に対し肝膵同時切除が行われるようになってきた.しかし, その予後はきびしく長期生存例はきわめて少ないのが現状である.そのなかでわれわれは最近肝膵同時切除兼右半結腸切除を行い5年の生存を得た症例を経験した.症例は54歳, 男性.1986年5月, 右季肋部痛出現し6月2日当科入院.肝, 十二指腸, 結腸へ直接浸潤のみられる進行胆嚢癌と診断された.6月18日拡大肝右葉切除兼膵頭十二指腸切除兼右半結腸切除を施行した.進展様式は胆道癌取扱い規約に準じるとpat-Gbfn, por, int, INFβ, si, hinf3, binf0, n (-), P0, H0でR3絶対治癒切除であった.術後大きな合併症はなく第84病日に退院.44kgであった体重は現在51kgまで回復している.CTで脂肪肝は認めるが再発徴候はなく生存中である.本症例が長期生存できたのは進行癌にも関わらず肝十二指腸靱帯への浸潤とリンパ節転移のながったことが大きな要因と考えられる.