万代 恭嗣¹, 幕内 雅敏¹, 伊藤 徹¹, 渡辺 五朗¹, 神谷 喜八郎¹, 二川 俊二¹, 杉浦 光雄¹, 和田 達雄¹, 仁科 孝子², 室井 龍夫³

Yasutsugu BANDAI¹, Masatoshi MAKUUCHI¹, Toru ITO¹, Goro WATANABE¹, Kihachiro KAMIYA¹, Shunji FUTAGAWA¹, Mitsuo SUGIURA¹, Tatsuo WADA¹, Takako NlSHINA², Tatsuo MUROI³

¹東京大学医学部第二外科, ²東京大学医学部小児外科, ³自衛隊中央病院外科

¹Second Department of Surgery, Faculty of Medicine, University of Tokyo, ²Pediatric Surgery, Faculty of Medicine, University of Tokyo, ³Department of Surgery, Central Hospital of Japanese Self Defence Forces

キーワード : negative cholecystogram, gallbladder cancer, cholecystolithiasis, ultrasound diagnosis, gallbladder wall

　39 cases with cholecystolithiasis and 13 cases with carcinoma of the gallbladder with negative cholecystograms by intravenous cholangiography, were analysed. Echo patterns of cholecystolithiasis were classified into five groups. Overall diagnostic accuracy of cholecystolithiasis was 89 %. Echograms of inflammatory thickened gallbladder walls were obtained in certain cases. These were mostly dmonstrated asta low echo area of the shape of the doughnut or horseshoe. Similar sonograms, however, were occasionally demonstrated also in cases with carcinoma. During acute cholecystitis, irregular echoes in the lumen which simulated malignant changes were noted in the gallbladder. Reexamination after two to three weeks invariably resulted in demonstration of fluid-fluid level in the gallbladder to validate benignity of the lesion. In cases without of the gallbladder cystic pattern, careful scanning is mandatory to detect the low echo area which frequently indicates thickened wall of the gallbladder. Once the ultrasonograms suggested the presence of the thickened wall, operation should be recommended under the consideration of malignant alternation of the organ.