Shuhei Iida

Postresection autopsy findings in patients with cancer of the main hepatic duct junction.

Extensive resection of the bile ducts combined with hepatic resection is the procedure of choice for carcinoma of the main hepatic duct junction. Currently this procedure is done without great risk, and increasing long‐term survival is now the issue. For this purpose, it is necessary to elucidate the biologic properties of the cancer to take reasonable measures. Autopsy findings of patients who died of recurrence may offer a reliable guide. Autopsy findings were studied in 14 patients: eight who had undergone curative resection and six who had received noncurative resection. Cancer recurred at the liver hilum with invasion into adjacent organs. Peritoneal dissemination and lymph node metastases were infrequent. These were common findings in both curative and noncurative resection groups. Cancer cells in the connective tissue of the hepatoduodenal ligament may play a major role in recurrence.

Long-term survival of patients with hepatocellular carcinoma combined with liver cirrhosis. Report of two patients.

Two patients with hepatocellular carcinoma combined with liver cirrhosis lived more than 5 years after hepatic resection. One patient with liver cirrhosis combined with schistosomiasis japonica survived 5 years and 2.5 months after left lobectomy and died of liver failure. Two recurrent tumors, each 1 cm in diameter, were present in the remaining lobe but were not responsible for death. Another patient is well 9 years and 2 months after extended right lobectomy. The tumor was bulky, and the resected specimen was 2800 g in weight. These facts show that patients with hepatocellular carcinoma combined with liver cirrhosis can survive for a long period even if a large tumor is involved.

A case report of congenital esophago-bronchial fistula with two diverticula in the adult.

憩室を伴う成人の食道気管支瘻で, 成因, 発症においてきわめて示唆に富む1例を経験した. 症例は68歳男性, 中部食道右壁に2個の憩室を認める. 肛側憩室より毛髪様に伸びる狭小な瘻管が, 4年間のうちにより太く拡張し, 右B7区域枝との交通が確認される過程を偶然追跡した. 外科的に瘻管を切除し治癒せしめたが, Brunner, 唐沢の診断基準より先天性のものと考えた. さらに, 術中口側の憩室より肺実質に向かう索状物を認めたが, このような索状物が気道に開存して瘻管となった例, 2個の憩室から異時性に食道気管支瘻を認めた症例が報告されており, 先天性食道気管支瘻の潜在的な病態ではないかと考えた. 加齢に伴う組織の弾力性の消失に喫煙, 飲酒, 上気道感染など外的要因が加わり, 瘻管壁を押し拡げようと働く力が増大した結果, ある時期を境に発症, 増悪してくるものと思われる.