Kunio Sakuramoto

Diagnostic evaluation of CT and ERCP based on a retrospective analysis of hepato-biliary and pancreatic diseases

A retrospective analysis was performed in order to evaluate diagnostic accuracies by computed tomography (CT) and by endoscopic retrograde cholangiopancreatography (ERCP). Materials studied were 67 lesions out of 56 cases with hepato-biliary and pancreatic diseases confirmed mainly at surgery. Diagnostic accuracy of the CT & ERCP for the hepatobiliary lesions was 59.5% & 86.5% and that of CT & ERCP for the pancreatic lesions was 60% & 80% respectively. CT scan is useful for diagnosing abscess, cyst or tumors. On the contrary, lesions which invade the hepatobiliary tract or pancreatic duct can be readily diagnosed by ERCP examination. ERCP is less useful for the diagnosis of parenchymatous lesions or infiltration of lesions into the surrounding organs. Therefore, the combined use of both CT and ERCP is important for the diagnosis of hepato-biliary or pancreatic disease.

A Study of Total Gastrectomy for Gastric Carcinoma in the Aged.

70歳以上高齢者胃癌全摘手術56例の術前検査成績 (検査異常項目数), 癌の進行度 (stage, P因子, H因子), 手術侵襲 (Rnumber, 他臓器合併切除, 開胸, 出血量, 手術時間) と合併症発生率, 在院死亡率との関連を検討した.合併症発生率は23.2%, 在院死亡率は17.9%で, 合併症は縫合不全, イレウス, 心筋梗塞が多く, 主なる死因は呼吸不全, 心不全であった.術前検査成績, stage, 手術侵襲と合併症発生に相関はなかったが, P(+), H(+)群の合併症発生はP0, H0群より有意に高率であった.高齢者胃癌に対して積極的に全摘手術を選択し, 腹部大動脈周囲リンパ節郭清を含むR2以上郭清, 他臓器合併切除により, 治癒切除を目指すべきであるが, P(+), H(+)群に対する全摘手術の適応は極めて乏しい.

Indication of proximal gastrectomy for cancer of upper part of the stomach with special reference of growth and infiltrative pattern of cancer.

胃上部癌に対する噴門側切除術の適応を検討する目的で, 胃上部癌59例を, 噴門部癌23例と非噴門部癌36例に分け, リンパ節転移, 胃上部癌の発育・進展様式, 遠隔成績から検討した.その結果根治性を失わないための胃上部癌に対する噴門側切除の適応としては, 壁内進展の面からは, 胃上部に限局し, 漿膜浸潤は認めず, 腫瘍長径4cm未満, さらに肛門側切離線まで表在癌2cm, 限局型3cm, 浸潤型5cmの距離を保つことと考えられた.またリンパ節転移からは, No.5, No.6, No.4dリンパ節に転移のない場合と考えられ, No.5リンパ節との関連からNo.3リンパ節への転移も重要な適応決定因子となると考えられた.

Study on cases of nonvisualized cholecystogram by the use of ERCP

We use Endoscopic Retrograde Cholangiopancreatography (ERCP) in 77 patients in whom oral cholecystography failed to visualize the gallbladder. ERCP did not visualize the gallbladder in 42%, and poorly visualized it in 58%, however, there was no significant difference in the disease distribution between non- and poorly visualized cases. 63 of the 77 patients underwent surgery. In cases postoperatively diagnosed as gallbladder carcinoma, the prognosis was better in poorly than in non-visualized gallbladder cases. Non- or poor visualization by ERCP in operated cases was due to gallstones in 71%, to common duct stones with intrahepatic calculi in 22%, and to malignant tumors in 17.5%. Our findings suggest that non-visualization of the gallbladder by ERCP should alert the diagnostician to the possibility of malignancy, especially in patients over 50 years of age.