[原著］進行胆嚢癌に対する肝切除術式の選択

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Several different procedures for performing a hepatic resection have been used in the surgical treatment of gallbladder carcinoma (GBC), such as a hepatic wedge resection (HWR), a S4a+S5 resection, a right lobectomy, or an extended right lobectomy. In the present study, we tried to compare the differences in the surgical indications between HWR and other larger hepatic resections, regarding to the depth of invasion of GBC. Between January 1996 and September 2000, 12 patients underwent HWR and S4a+S5 resection for GBC, in which the depth of invasion reached the mucosal layer (m) in 1 patient, the muscular layer (mp) in 1, the subserosal (ss) layer in 4, the serosal (se) layer in 3, and the other organ (si) in 3. All 6 patients with m, mp, or ss invasion underwent curative resections, thus resulting in a significantly longer median survival time ($73.0 \pm 71.8$ months after surgery), compared to those 6 patients with either se or si ($7.8 \pm 4.1$ months). In one patient with se (hinflb) invasion, the pathological finding of the invaded hepatic parenchyma showed a rich interstitial segment, which was accompanied by cancerous lymphopathy in the portal tract causing microscopic lymphatic metastasis along with the portal tract. In conclusion, HWR for the GBC patients with mp or ss invasion could be used as the standard surgical procedure, with an excellent survival rate after surgery. GBC patients with hepatic parenchymal invasion, however, should be treated by either a segmental or lobal hepatic resection, in order to control the spread of lymphatic expansion along with the portal trac.
琉球医学会,Ryukyu Medical Associationの論文

[原著］進行胆嚢癌に対する肝切除術式の選択

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