<総説>無黄疸期に発見された下部胆管癌および十二指腸乳頭部癌について

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Carcinomas arising from the lower bile duct (BiC) and from the papilla of Vater (VC) have been seldom found before the development of jaundice ; 19 cases of BiC and 93 of VC in their nonicteric stage, including our own cases, have been reported in the Japanese literature since 1980. In patients of BiC, their ages ranged from 51 years to 77 with a mean age of 64.2 years and with a male-to-female ratio of 1 : 1. In patients of VC, their ages ranged from 25 years to 79 with a mean of 59.7 and with the sex ratio of 1 : 1.2. Clinical symptoms of each carcinoma were not characteristic, and abnormally elevated values of serum enzymes reflecting the disturbed bile flow were the first diagnostic clue in the majority. Ultrasonography (US) and endoscopic retrograde cholangiopancreatography were most useful for the diagnosis of BiC. On the other hand, VC was detected mainly by hypotonic duodenography, fiberoptic duodenoscopy and endoscopic biopsy. Sufficient resection was performed on all of the BiC-patients and 93 percent of the VC-patients. Although various macroscopic types were noted, relatively small size and histologically highly differentiated adenocarcinoma of the resected specimens were the usual findings of BiC. The high frequency of protruded type in gross appearance, occurrence from the duodenal mucosa or from the common channel, relatively small size and histology similar to that of BiC were characteristic in VC. In practice, nonicteric patients with vague complaints and abnormally elevated levels of serum enzymes such as alkaline phosphatase, should be further studied to judge of the possibility of BiC or VC. Abnormally dilated biliary ductal system on US should not be overlooked. The high detectability of so-called carcinoma in the relatively early stage in the present survey (63 percent in BiC and 58 percent in VC) may promise the high curability.
近畿大学の論文
1988-12-25

<総説>無黄疸期に発見された下部胆管癌および十二指腸乳頭部癌について

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