井利 雅信¹, 竹原 靖明^{2, 5, 6}, 松澤 一彦², 山田 清勝², 鳥海 修², 黒瀬 実香², 小島 正久³, 田中 一成¹, 安井 英明⁴

Masanobu IRI¹, Yasuaki TAKEHARA^{2, 5, 6}, Kazuhiko MATSUZAWA², Kiyokatsu YAMADA², Osamu TORIUMI², Mika KUROSE², Masahisa KOJIMA³, Issei TANAKA¹, Hideaki YASUI⁴

¹公立学校共済組合関東中央病院外科, ²公立学校共済組合関東中央病院画像診断科, ³公立学校共済組合関東中央病院健康管理科, ⁴公立学校共済組合関東中央病院病理, ⁵新横浜病院, ⁶東京紙商健保組合診療所

¹Department of Surgery, Kanto Central Hospital, ²Department of Diagnostic Imaging, Kanto Central Hospital, ³Department of Health Care, Kanto Central Hospital, ⁴Department of Pathology, Kanto Central Hospital, ⁵Shin-Yokohama Hospital, ⁶Tokyo Kamisho-Kempokumiai Clinic

キーワード : Gallbladder cancer , Infiltration into the subserosa , Layered structure , Ultrasonographic diagnosis

Ultrasonograms of cases of resected gallbladder cancers that had infiltrated into the subserous layer (ss gallbladder cancer) were studied in terms of the layered structure of the gallbladder wall and the echo produced by the lesion. The subjects were 15 patients with ss gallbladder cancers that were resected at the Kanto Central Hospital. These cancers were classified into two groups: Group A contained cases in which the lateral high-echo layer of the lesion was maintained on abdominal ultrasonography (abbreviated here as US); group B, cases in which either the lateral high-echo layer of the lesion not maintained or the lesion could not be assessed, groups B-1 and B-2, respectively. Group A contained 6 cases; group B, 9 cases (2 in subgroup B-1 and 7 in subgroup B-2). The US echo from the central part of lesions in group A was lower and less even than that of the marginal region. Histopathologically, the cancer had infiltrated into the subserous fibrous layer (ss fibrous layer) and was accompanied by fibrosis in the region, but there was a subserous fat layer (ss fat layer) free from cancerous infiltration outside of the region. In group B, the US echo from the central part of the lesion was lower and less even than that of the marginal region. The lateral high-echo layer was irregular, thinning, and interrupted. Histopathologically, the cancer had infiltrated into the deep part of the ss and was accompanied by fibrosis in the region, in which the ss fat layer was almost completely absent. Three types of resection were performed: simple cholecystectomy, 4 cases; cholecystectomy +R₁ lymph node dissection, 1 case; and hepatectomy (S 4 aS 5 resection 1 case; liver-bed resection, 9 cases) accompanied by R₂ lymph node dissection, 10 cases. Liver-bed resection and R₂ lymph node dissection were performed in all cases in group A, and the patients are all alive. Patients in group A tended to have a survival advantage over those in group B (p2 lymph node dissection for the cases in group A could possibly bring about a good prognosis.