¤ł¤ł ¤Ť¤é ˝ü¤¤ ĽŃĽÁĽóĽł


’_“š‚Ş‚ń@`f—ĂƒKƒCƒhƒ‰ƒCƒ“

ƒKƒCƒhƒ‰ƒCƒ“•ś’†‚Ě•śŒŁ”ԍ†‚Š‚çCŠY“–‚ˇ‚é\‘˘‰ť´˜^‚ĚŽQĆ‚Ş‚Ĺ‚Ť‚Ü‚ˇ

–ÚŽŸ:


—\–hE‰uŠw

ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ1
’_“šŠŕ‚ĚƒnƒCƒŠƒXƒN‚ɂ͂ǂ̂悤‚Č‚ŕ‚Ě‚Ş‚ ‚é‚ŠH

’_ŠÇŠŕ‚ĚƒnƒCƒŠƒXƒN‚É‚Í’_ŠÇŠg’ŁŒ^‚ĚäXE’_ŠÇ‡—ŹˆŮíAŒ´”­Ťd‰ťŤ’_ŠÇ‰Š‚Ş‚ ‚°‚ç‚ę‚éB
’_”XŠŕ‚ĚƒnƒCƒŠƒXƒN‚É‚ÍäXE’_ŠÇ‡—ŹˆŮí‚Ş‚ ‚°‚ç‚ę‚éB
\“ńŽw’°“ű“Ş•”Šŕ‚ɂ̓Gƒrƒfƒ“ƒX‚Ě‚ ‚éƒnƒCƒŠƒXƒN‚Č•a‘Ԃ݂͂‚Š‚Á‚Ä‚˘‚Č‚˘B

„§“x‚Č‚ľ

‰đŕ

’_“šŠŕ‚͐Ť•Ę‚É‚ć‚Á‚ÄŠŕ‚Ě”­ś•”ˆĘ‚ŞˆŮ‚Č‚éŒXŒü‚Ş•ń‚ł‚ę‚Ä‚¨‚čA’_”XŠŕ‚͏—Ť‚É‘˝‚­’_ŠÇŠŕ‚Í’jŤ‚É‘˝‚˘B‚Ü‚˝lŽíA’nˆć‚É‚ć‚鍷‚ŕ•ń‚ł‚ę‚Ä‚¨‚čAlŽí‚Ĺ‚Í’_”XŠŕ‚ÍAsian-Pacific ‚âHispanic, Native American ‚É‘˝‚­ACaucasian ‚ɏ­‚Č‚˘1jB‚Ü‚˝’nˆć‚Ĺ‚ÍƒCƒ“ƒh–k•”‚â“ě•Äƒ`ƒŠA“Œ‰˘ƒ|[ƒ‰ƒ“ƒh‚Č‚Ç‚É‘˝‚˘‚Ć•ń‚ł‚ę‚Ä‚˘‚邢2jBˆę•űA’_“šŠŕ‚Ě”­Šŕ‚É‚Í’_“š‚É‚¨‚Ż‚閝Ť“I‚ȉŠÇ‚𐜂ś‚é•a‘Ô‚ĚŠÖ—^‚ŞŽw“E‚ł‚ę‚Ä‚˘‚éBˆČ‰ş‚ÉŠeŠŕŽí‚ĚƒnƒCƒŠƒXƒN‚đ‹“‚°‚éB

‚Pj’_ŠÇŠŕ‚ĚƒnƒCƒŠƒXƒN

äXE’_ŠÇ‡—ŹˆŮíiCQ2 ŽQĆj

’_ŠÇŠg’ŁŒ^‚Ĺ‚Í’_”XŠŕA’_ŠÇŠŕ‚Ě”­ś‚Ş‘˝‚­A’_ŠÇ”ńŠg’ŁŒ^‚Ĺ‚Í’_”XŠŕ‚Ě”­ś—Ś‚Ş‘˝‚˘‚ą‚Ć‚Ş•ń‚ł‚ę‚Ä‚¨‚č3j4jA—\–h“I‚ČŽčp‚Ş•K—v‚Ć‚ł‚ę‚éB

Œ´”­Ťd‰ťŤ’_ŠÇ‰Š

Œ´”­Ťd‰ťŤ’_ŠÇ‰Š‚́AŒĂ‚­‚Š‚ç‰uŠw“I‚É’_ŠÇŠŕ‚Ě”­ś‚ÉŠÖ—^‚ˇ‚é‚Ć‚ł‚ę‚Ä‚˘‚éBisŠŕ‚Ş‘˝‚­A—\Œă‚ŕ•s—Ç‚Ĺ‚ ‚é‚ą‚Ć‚Š‚çƒnƒCƒŠƒXƒN‚Ć‚ľ‚ÄŒľd‚ČŒo‰ßŠĎŽ@‚Ş•K—v‚Ć‚ł‚ę‚éB

ŠĚ“ŕŒ‹ÎÇ

ŠĚ“ŕŒ‹ÎÇ‚ĆŠĚ“ŕ’_ŠÇŠŕ‚ĚŠÖ˜AŤ‚ÉŠÖ‚ľ‚Ä‚ÍˆČ‘O‚ć‚č‘˝”‚Ě•ń‚Ş‚ł‚ę5j6jA–{–M‚É‚¨‚Ż‚éĹ‹ß‚ĚƒRƒz[ƒg’˛¸‚É‚¨‚˘‚Ä‚ŕ’_“šŠŕ‚̍‡•š—Ś‚Í5.4%‚Ć•ń‚ł‚ę‚Ä‚¨‚č7jA90“ˆČă‚ĚŠŕ‚ÍŒ‹Î‚Ě‘śÝ•”ˆĘ‚É‚ ‚é‚ą‚Ć‚Š‚疝Ť“I‚Č’_ŠÇ‚̉ŠÇ‚Əă”ç‚̏áŠQ‚Ş”­Šŕ‚ĚŒ´ˆö‚ƍl‚Ś‚ç‚ę‚Ä‚˘‚éB

‚Qj’_”XŠŕ‚ĚƒnƒCƒŠƒXƒN

äXE’_ŠÇ‡—ŹˆŮí

Šg’ŁŒ^A”ńŠg’ŁŒ^‚đ–â‚킸’_”XŠŕ‚͍‚•p“x‚ɍ‡•š‚ˇ‚é‚ą‚Ć‚Ş’m‚ç‚ę‚Ä‚¨‚čA—\–h“I‚Č“Eop‚ĚŽ{s‚Í•K{‚Ĺ‚ ‚éBÚ×‚ÍCQ2 ‚đŽQĆ‚Ě‚ą‚ƁB

’_”Xƒ|ƒŠ[ƒviCQ4ACQ43 ŽQĆj

”ě–žA‚Ž‰ŒŒÇAƒƒ^ƒ{ƒŠƒbƒNƒVƒ“ƒhƒ[ƒ€A‚ť‚Ě‘ź

’_“šŠŕ‚̉uŠwŒ¤‹†‚É‚¨‚˘‚Ĕ얞A‚Ž‰ŒŒÇA“œ”A•aA‚Ž‰–bHŰŽćAƒgƒEƒKƒ‰ƒV‚Ě‰ßčŰŽćA‰ş‘wŠK‹‰A‚Č‚Ç‚ŞŠëŒŻˆöŽq‚Ć‚ľ‚Ä‚ ‚°‚ç‚ę‚Ä‚˘‚éB‹t‚ɉʕ¨‚̐ێćA“¤—ނ̐ێćA“œ”A•a‚ĚƒRƒ“ƒgƒ[ƒ‹‚Č‚Ç‚ŞŠëŒŻ‚đ’ቺ‚ł‚š‚éˆöŽq‚Ć•ń‚ł‚ę‚Ä‚˘‚é8-10jB

\“ńŽw’°“ű“Ş•”Šŕ‚ĚƒnƒCƒŠƒXƒN

“ű“Ş•”Šŕ‚ĚƒnƒCƒŠƒXƒN‚Ć‚˘‚Ś‚é•a‘Ô‚Ě•ń‚Í‚Č‚˘B

“ű“Ş•”‘BŽî‚Í‘OŠŕó‘Ô‚Ćl‚Ś‚ç‚ę‚Ä‚˘‚é11jiCQ43 ŽQĆjBśŒŸ‚Ĺ‘BŽî‚̐f’f‚Ş“ž‚ç‚ę‚Ä‚ŕ[•”‚ÉŠŕ‚Ş‘śÝ‚ˇ‚é‚ą‚Ć‚ŕ‹H‚Ĺ‚Í‚Č‚­Atotal biopsy ‚ĚˆÓ–Ą‚ŕŠÜ‚ß‚˝Řœ‚Ş•K—v‚Ć‚Č‚éiCQ31 ŽQĆjB‚Ü‚˝\“ńŽw’°“ű“Ş•”‘BŽî‚͉Ƒ°Ť‘ĺ’°‘BŽîÇiFAPj‚ƍ‡•š‚ˇ‚é‚ą‚Ć‚Ş‘˝‚˘‚ą‚Ć‚ŕ•ń‚ł‚ę‚Ä‚¨‚č12jAFAP Ç—á‚É‚¨‚˘‚Ä‚Íă•”Á‰ťŠÇ‚ĚŒŸ¸‚đs‚¤Ű‚É“ű“Ş•”‚Ü‚ĹŠĎŽ@‚đs‚¤‚ą‚Ć‚Í•K{‚Ć‚ł‚ę‚Ä‚˘‚é13jBiƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Cj

ŽQl•śŒŁ

1j Goodman MT, Yamamoto J: Descriptive study of gallbladder, extrahepatic bile duct, and ampullary cancers in the United States, 1997-2002. Cancer Causes Control.2007; 18: 415-22.

2j Serra I, Yamamoto M, Calvo A, Cavada G, Báez S, Endoh K, Watanabe H, Tajima K.@Association of chili pepper consumption, low socioeconomic status and longstanding gallstones with gallbladder cancer in a Chilean population.@Int J Cancer. 2002; 102: 407-411.

3j XŞ—T“ńA“‡“cŒőśA‹vŽRŽőŽqA‚ź‰p•vA“c‘㐪‹L: ‘S‘WŒv‚Š‚ç‚Ý‚˝ć“VŤ’_“šŠg’ŁÇAäXE’_ŠÇ‡—ŹˆŮí‚Ě’_“šŠŕ”­ś—Ś‚Ć‚ť‚Ě“Á’ĽA’_‚ĆäX2010; 31: 1293-1299.

4j Funabiki T, Matsubara T, Miyakawa S, Ishihara S.: Pancreaticobiliary maljunction and carcinogenesis to biliary and pancreatic malignancy. Langenbecks Arch Surg. 2009 394: 159-69.

5j Ohta T, Nagakawa T, Ueda N, Nakamura T, Akiyama T, Ueno K, Miyazaki I. Mucosal dysplasia of the liver and the intraductal variant of peripheral cholangiocarcinoma in hepatolithiasis. Cancer. 1991 15; 68: 2217-2223.

6j Nakanuma Y, Terada T, Tanaka Y, Ohta G. Are hepatolithiasis and cholangiocarcinoma aetiologically related? A morphological study of 12 cases of hepatolithiasis associated with cholangiocarcinoma. Virchows Arch A Pathol Anat Histopathol. 1985; 406: 45-58.

7j XrKA—é–Ř—TA™ŽRł‘ĽAŐŒŠ—TAŠĚ“ŕŒ‹ÎÇ. ’_“š 2009, 23: 80-87.

8j Shebl FM, Andreotti G, Rashid A, Gao YT, Yu K, Shen MC, Wang BS, Li Q, Han TQ, Zhang BH, Fraumeni JF Jr, Hsing AW.: Diabetes in relation to biliary tract cancer and stones: a population-based study in Shanghai, China.@Br J Cancer.2010; 103: 115-119.

9j Serra I, Yamamoto M, Calvo A, Cavada G, Báez S, Endoh K, Watanabe H, Tajima K. Association of chili pepper consumption, low socioeconomic status and longstanding gallstones with gallbladder cancer in a Chilean population. Int J Cancer. 2002, 102: 407-411.

10j Matsuba T, Qiu D, Kurosawa M, Lin Y, Inaba Y, Kikuchi S, Yagyu K, Motohashi Y, Tamakoshi A; JACC Study Group: Overview of epidemiology of bile duct and gallbladder cancer focusing on the JACC Study.J Epidemiol.2005 vol 15.

11j Cattell RB, Pyrtek LJ. Premalignant lesions of the ampulla of Vater. Surg Gynecol Obstet. 1950; 90: 21-30.

12j Pauli RM, Pauli ME, Hall JG.@Gardner syndrome and periampullary malignancy. Am J Med Genet. 1980; 6: 205-219.

13j Iida M, Yao T, Itoh H, Watanabe H, Matsui T, Iwashita A, Fujishima M. Natural history of duodenal lesions in Japanese patients with familial adenomatosis coli (Gardner's syndrome). Gastroenterology. 1989; 96: 1301-1306.


ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ2
äXE’_ŠÇ‡—ŹˆŮí‚É—\–h“IŽĄ—Ă‚Í•K—v‚ŠH

’_ŠÇŠg’ŁŒ^‚ĚäXE’_ŠÇ‡—ŹˆŮí‚ɑ΂ľ‚Ä‚Í—\–h“I’_”X“Eo‚ĆŠĚŠO’_ŠÇŘœ‚Ş•K—v‚Ĺ‚ ‚éB
’_ŠÇ”ńŠg’ŁŒ^äXE’_ŠÇ‡—ŹˆŮí‚ɑ΂ľ‚Ä‚Í—\–h“I’_”X“Eo‚Ş•K—v‚Ĺ‚ ‚éB

„§“x: 1@ƒGƒrƒfƒ“ƒXƒŒƒxƒ‹C

‰đŕ

äXE’_ŠÇ‡—ŹˆŮí‚͉đ–UŠw“I‚ÉäXŠÇ‚Ć’_ŠÇ‚ޏ\“ńŽw’°•ÇŠO‚ō‡—Ź‚ľ‚Ä‚˘‚éć“VŤ‚ĚŒ`ŹˆŮí‚Ć’č‹`‚ł‚ę1jA‹¤’ĘŠÇ‚Ş’ˇ‚­AOddi Š‡–ń‹Ř‚̍ě—p‚ŞäXŠÇ‚Ć’_ŠÇ‚̍‡—Ź•”‚É‹y‚΂Ȃ˘‚ą‚Ć‚Š‚çäX‰t‚Ć’_`‚Ě‘ŠŒÝ‹t—Ź‚𐜂śA‚ť‚ę‚É‚ć‚č’_“šAäX‚É‚ł‚Ü‚´‚Ü‚Č•a‘Ô‚đˆř‚Ť‹N‚ą‚ˇ‚ą‚Ć‚Ş’m‚ç‚ę‚Ä‚˘‚éB’_ŠÇ‚ĚŒ`‘Ô‚Š‚ç’_ŠÇŠg’ŁŒ^‚Ć”ńŠg’ŁŒ^‚É•Ş—Ţ‚ł‚ę‚éBĹ‚ŕ–â‘č‚Ć‚Č‚é•a‘Ô‚Í’_“šŠŕ‚Ě”­ś‚Ĺ‚ ‚čA”­Šŕ‚ĚŒ´ˆö‚Í‹t—Ź‚ľ‚˝äX‰t‚Ş’_`‚ƍŹ˜a‚ˇ‚é‚ą‚Ć‚É‚ć‚č×–EŠQŤ‚Ě‹­‚˘•¨Žż‚ŞŽYś‚ł‚ęA’_“šă”ç‚É–Ť“I‚ȉŠÇ‚𐜂ś‚é‚ą‚ƂƐ„‘Ş‚ł‚ę‚Ä‚˘‚é2-4jB

’_ŠÇŠg’ŁŒ^‚ĚäXE’_ŠÇ‡—ŹˆŮí‚Ĺ‚Í’_”XŠŕA’_ŠÇŠŕ‹¤‚ɍ‚—Ś‚Ĺ‚ ‚čA•W€“IŽĄ—Ă‚Í—\–h“I’_”X“Eo‚ĆŠĚŠO’_ŠÇŘœp‚ƍl‚Ś‚ç‚ę‚Ä‚˘‚é5jBˆę•űA’_ŠÇ”ńŠg’ŁŒ^‚Ĺ‚Í’_”XŠŕ‚Ě”­ś‚Í”ńí‚ɍ‚—Ś‚Ĺ‚ ‚č—\–h“I’_”X“Eo‚đs‚¤‚ą‚Ć‚ÉŠÖ‚ľ‚ÄˆŮ˜_‚Í‚Č‚˘‚ށA’_ŠÇŘœ‚ÉŠÖ‚ľ‚Ä‚Í“ˆę‚ľ‚˝ŒŠ‰đ‚Ş“ž‚ç‚ę‚Ä‚˘‚Č‚˘‚Ě‚ŞŒťó‚Ĺ‚ ‚é6-9jB

—\–h“IŽĄ—Ă‚ĚŽ{sŽžŠú‚ÉŠÖ‚ľ‚Ä‚Í–žŠm‚ČƒGƒrƒfƒ“ƒX‚Í‚Č‚˘‚ސf’fŠm’čŒă‚Í‘Šú‚ĚŽčp‚ސ„§‚ł‚ę‚Ä‚˘‚é10jB

ŽQl•śŒŁ

1j “ú–{äXŠÇ’_“š‡—ŹˆŮíŒ¤‹†‰ď‡—ŹˆŮíf’fŠî€ŒŸ“˘ˆĎˆő‰ďAäXE’_ŠÇ‡—ŹˆŮí‚̐f’fŠî€i‰ü’čj‘D‰gF•F@•Ň: äXE’_ŠÇ‡—ŹˆŮí@‚ť‚ĚConsensus ‚ĆControversy. “Œ‹ž: ˆăŠw}‘o”Ĺ1997; 1-4.

2j Shimada K, Yanagisawa J, Nakayama F: Increased lysophosphatidylcholine and pancreatic enzyme content in bile of patients with anomalous pancreaticobiliary ductal junction. Hepatology 1991; 13: 438-444.

3j _ŕV‹P”üAäX‰t’_“šA’_`äXŠÇ‹t—ŹŒťŰ‚Ě—Ő°‚Ć•a‘ԁA’_“š2007; 21: 497-505.

4j Funabiki T, Matsubara T, Miyakawa S, Ishihara S.: Pancreaticobiliary maljunction and carcinogenesis to biliary and pancreatic malignancy. Langenbecks Arch Surg. 2009 ; 394: 159-169.

5j Takeshita N, Ota T, Yamamoto M.: Forty-year experience with flow-diversion surgery for patients with congenital choledochal cysts with pancreaticobiliary maljunction at a single institution. Ann Surg. 2011; 254: 1050-1053.

6j Ohuchida J, Chijiiwa K, Hiyoshi M, Kobayashi K, Konomi H, Tanaka M.: Long-term results of treatment for pancreaticobiliary maljunction without bile duct dilatation.@Arch Surg 2006; 141: 1066-1070.

7j ‘ž“cŠx—mAŒáČŽiA’|‰şMŒ[AA‘şCˆę˜YAŹŠŃŒšˆę˜YA’JŕV•‹vAŠŽR‰pŽ÷A”óŒű—ş‘žAVˆä“c’B—YAŽR–{‰ëˆęA: ’_ŠÇ”ńŠg’ŁŒ^äXE’_ŠÇ‡—ŹˆŮí‚ɑ΂ˇ‚鎥—Ă•űj|’_ŠÇ”ńŘœ‚Ě—§ę‚Š‚ç|@äXE’_ŠÇ‡—ŹˆŮí‚̐V‚˝‚Č“WŠJ|ŠT”OA‰uŠwAf’fAŽĄ—Ă‚Ě‘“_ŒŸ|ˆăŠw‘‰@@2011 153-160.

8j ‚‰Ž•~—™A–Ř‘ş•ś•vA´…G–žA‹g—Ż”Ž”VA‘ĺ’ː­”VA‰Á“ĄŒúA‹g•yGKAŒĂěŸ‘ĽA’|“ŕ’jA{“c_‰îA‚–ědĐA‹v•Ű–Ř—FA‹{čŸ: ”ńŠg’ŁŒ^äXE’_ŠÇ‡—ŹˆŮí‚ɑ΂ľ‚Ä’_”X“Eop‚Ĺ—Ç‚˘‚ŠH ’_‚ĆäX@2001; 31,1287-1292.

9j Tsuchida A,Itoi T, Endo M, Kitamura K, Mukaida M, Itokawa F, Ozawa T, Aoki T.Pathological features and surgical outcome of pancreaticobiliary maljunction without dilatation of the extrahepatic bile duct. Oncol Rep 2004; 11: 269-276.

10j Saikusa N, Naito S, Iinuma Y,Ohtani T, Yokoyama N, Nitta K; Invasive cholangiocarcinoma identified in congenital biliary dilatation in a 3-year-old boy. J pediatr Surg. 2009; 44: 2202-2205.


ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ3
–łÇŒóŤ’_ÎÇ‚É‚¨‚Ż‚é’_”XŠŕ‚Ě—\–h–Ú“I‚Ĺ‚Ě’_”X“Eop‚͈Ӌ`‚Ş‚ ‚é‚ŠH

’_”XŒ‹ÎÇ‚Ć’_”XŠŕ‚Ć‚Ě’źÚ“Iˆö‰ĘŠÖŒW‚ÍŘ–ž‚ł‚ę‚Ä‚¨‚炸C–łÇŒóŤ’_ÎÇ‚ɑ΂ˇ‚é—\–h“I‚Č’_”X“Eop‚ĚˆÓ‹`‚Í‚Č‚˘B

„§“x‚Č‚ľ

‰đŕ

’_”XŠŕ‚É’_Î‚ލ‡•š‚ˇ‚é•p“x‚͍‚‚˘‚ށAćs‚ˇ‚é’_Î‚Ě‘śÝ‚É‚ć‚č’_”XŠŕ”­ś•p“x‚Ş—LˆÓ‚É‘‰Á‚ˇ‚é‚Ć‚˘‚¤•ń‚Í‚Ý‚ç‚ꂸ1jCŒťŽž“_‚Ĺ‚Í’_Î‚Ć’_”XŠŕ‚Ć‚Ě’źÚ“Iˆö‰ĘŠÖŒW‚ÍŘ–ž‚ł‚ę‚Ä‚˘‚Č‚˘D

ˆę•ű‚ŁC’_”XŒ‹Î‚Ɛf’f‚ł‚ę‚Ä‚Š‚ç‚ĚŠúŠÔ‚Ş’ˇ‚˘Ç—á‚ł́Cf’f‚ł‚ę‚Ä‚Š‚ç‚ĚŠúŠÔ‚Ş’Z‚˘Ç—á‚É”ä‚ׂĒ_”XŠŕ‚Ě”­ś—Ś‚Ş—LˆÓ‚ɍ‚‚˘‚Ć‚ˇ‚é•ń2j‚â’_”XŒ‹Î‚Ě‚¤‚ż—LÇó—á‚Í–łÇó—á‚É”ä‚ׂĒ_”XŠŕ‚Ě”­ś—Ś‚ލ‚‚˘‚Ć‚ˇ‚é•ń3j‚âCŒ‹Î‚ĚƒTƒCƒY‚⌋Î‚̐”i—ʁj‚É‚ć‚č’_”XŠŕ‚Ě”­ś—Ś‚ŞˆŮ‚Č‚é‚Ć‚Ě•ń‚Ş‚Ý‚ç‚ę‚é4-6jB‚ł‚ç‚É’_Î‚Ě‘śÝ‚É‚ć‚č’_”X”S–Œ‚Ědysplasia ‚âmetaplasia ‚Ě”­ś—Ś‚ލ‚‚­‚Č‚é‚Ć‚Ě•ń‚ŕ‚ ‚é7-9jB

’_”XŒ‹Î‚Ɛf’f‚ł‚ę‚Ä‚Š‚ç‚ĚŠúŠÔ‚Ş’ˇ‚˘ę‡‚⌋Î‚ĚƒTƒCƒY‚Ş‘ĺ‚Ť‚­Œ‹Î”‚ŕ‘˝‚˘ę‡CŒ‹Î‚Ş’_”X“ŕ‚ɏ[–ž‚ľ‚Ä‚˘‚éę‡‚Ȃǂ́CŒÂX‚ĚÇ—á‚Ö‚Ě\•Ş‚ČƒCƒ“ƒtƒH[ƒ€ƒhƒRƒ“ƒZƒ“ƒg‚đ‚¨‚ą‚Č‚Á‚˝ă‚ŁC’_”X“Eop‚Ş‘Š‘ΓI“K‰ž‚Ć‚Č‚é‚ŞC–łÇŒóŤ’_ÎÇ‚Ěę‡‚Í’ˇŠúŠÔŒo‰ßŠĎŽ@‚ľ‚Ä‚ŕ’_”XŠŕ‚Ş”­ś‚ˇ‚éŠëŒŻŤ‚͏­‚Č‚­C’_”XŠŕ‚ɑ΂ˇ‚é—\–h“I’_”X“Eop‚đŠŠ‚ß‚éŞ‹’‚Í•s\•Ş‚Ĺ‚ ‚éB

–łÇŒóŤ’_ÎÇ‚É‚¨‚Ż‚é’_”XŠŕ‚Ě—\–h“I’_”X“Eop‚ĚˆÓ‹`‚ɂ‚˘‚Ä‚ÍěŹˆĎˆő‚É‚ć‚铢‹c‚Ĺ‚ŕˆÓŒŠ‚Ş•Ş‚Š‚ęC„§“x‚đ‚‚Ż‚é‚ą‚Ć‚ÉˆĎˆő‰ď‚Ć‚ľ‚č‡ˆÓ‚Ş“ž‚ç‚ę‚Č‚Š‚Á‚˝‚˝‚߁C–{CQ ‚͐„§“x‚Č‚ľ‚Ć‚ľ‚˝B

ŽQl•śŒŁ

1j Gracie WA, Ransohoff DF. The natural history of silent gallstones. N Engl J Med 1982; 307: 798-800.

2j Serra I, Yamamoto M, Calvo A, Cavada G, Baez S, Endoh K, Watanabe H, Tajima K. Association of chili pepper consumption, low socioeconomic status and longstanding gallstones with gallbladder cancer in a Chilean population. Int J Cancer 2002; 102: 407-411.

3j Scott TE, Carroll M, Cogliano FD, Smith BF, Lamorte WW. A case-control assessment of risk factors for gallbladder carcinoma. Dig Dis Sci 1999; 44: 1619-1625.

4j Lowenfels AB, Walker AM, Althaus DP, Townsend G, Domellof L. Gallstone growth, size, and risk of gallbladder cancer: an interracial study. Int J Epidemiol 1989; 18: 50-54.

5j Diehl AK. Gallstone size and the risk of gallbladder cancer. JAMA 1983; 250: 2323-2326.

6j Csendes A, Becerra M, Rojas J, Medina E. Number and size of stones in patients with asymptomatic and symptomatic gallstones and gallbladder carcinoma: a prospective study of 592 cases. J Gastrointest Surg 2000; 4: 481-485.

7j Yamagiwa H. Mucosal dysplasia of gallbladder: isolated and adjacent lesions to carcinoma. Jpn J Cancer Res 1986; 80: 238-243.

8j ŽRŰ—TŽj. ’_”XŽžŠł‚Ě—Ő°•a—i9j’_”XŒ‹Î‡•š‚Ě—L–ł‚É‚ć‚é’_”XŠŕ‚Ě”äŠr —Տ°•a— 1987; 35: 927-930.

9j ă–ěŒjˆę, ‰iě‘î˜a, ‹{čˆí•v. ’_Î‚Ć’_”XŠŕ. M B Gastro 1992; 2: 95-100.


ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ4
‚ǂ̂悤‚Č’_”Xƒ|ƒŠ[ƒv‚ɑ΂ľ‚Ä’_”X“Eop‚Í•K—v‚ŠH

’_”Xƒ|ƒŠ[ƒv‚Ş10mm ˆČă‚ŁC‚Š‚Â‰ć‘œă‘‘ĺŒXŒü‚đ”F‚ß‚éę‡C‚Ü‚˝‚Í‘ĺ‚Ť‚ł‚É‚Š‚Š‚í‚炸LŠîŤ‚Ěę‡C’_”XŠŕ‚Ě•p“x‚ލ‚‚­C’_”X“Eop‚ސ„§‚ł‚ę‚éB

„§“x2@ƒGƒrƒfƒ“ƒXƒŒƒxƒ‹C

‰đŕ

’_”XŠŕ‚Ě”­ś•ę’n•a•Ď‚Ć‚ľ‚Ä‘BŽî‚ŕ‚ľ‚­‚ÍˆŮŒ^ă”ç‚ŞdŽ‹‚ł‚ęC‚ł‚ç‚É’°ă”牝ś‚ĚŠÖ—^‚Ş•ń‚ł‚ę‚Ä‚˘‚é1, 2jB’_”XŘœ—á1,280 —á‚ĚŒŸ“˘‚ŁC‘BŽî‚Ě‚Ý‚Ě‚ŕ‚Ě‚Í‚˘‚¸‚ę‚ŕ1cm –˘–ž‚Ĺ‚ ‚čCˆę•űA2cm ‚đ‚ą‚Ś‚é‚Ć‚Ů‚Ć‚ń‚ÇŠŕ‰ť‚ľ‚Ä‚˘‚˝‚Ć‚Ě•ń3j‚âA’_”Xƒ|ƒŠ[ƒv‚̐f’f‚Ĺ’_”X“Eop‚Ş‚¨‚ą‚Č‚í‚ę‚˝Ç—á‚ĚŒŸ“˘‚Š‚çCƒ|ƒŠ[ƒv‚ĚŒa‚Ş10mm ˆČăC’P”­‚Ĺ‚ ‚é‚ą‚ƁC”N—î‚Ş60 ËˆČăALŠîŤC‘‘ĺŒXŒü‚đ”F‚ß‚éę‡‚É‚ÍŠŕ‚̉”\Ť‚ލ‚‚˘‚Ć‚Ě•Ą”‚Ě•ń‚Ş‚ ‚é4-9jB

‚ą‚ę‚ç‚ĚŒ‹‰Ę‚Š‚ç’_”Xƒ|ƒŠ[ƒv‚ÍŒa‚Ş10mm ˆČă‚ŁC‚Š‚Â‰ć‘œă‘‘ĺŒXŒü‚đ”F‚ß‚éę‡C‚Ü‚˝‚Í‘ĺ‚Ť‚ł‚É‚Š‚Š‚í‚炸LŠîŤ•a•Ď‚Ĺ‚Í’_”XŠŕ‚Ě•p“x‚ލ‚‚­C’_”X“Eopp‚Ě“K‰ž‚ƍl‚Ś‚ç‚ę‚é4-13jB

ŽQl•śŒŁ

1j Roa I, de Aretxabala X, Araya JC, Roa J. Preneoplastic lesions in gallbladder cancer. J Surg Oncol 2006; 93: 615-623.

2j Yamagiwa H. Mucosal dysplasia of gallbladder: isolated and adjacent lesions to carcinoma. Jpn J Cancer Res 1989; 80: 238-243.

3j ŽRŰ—TŽjD’_”XŽžŠł‚Ě—Ő°•a—i5j’_”X‚Ě‘BŽîD—Տ°•a—@1986; 34: 729-732.

4j Chijiiwa K, Tanaka M. Polypoid lesion of the gallbladder: indications of carcinoma and outcome after surgery for malignant polypoid lesion. Int Surg. 1994; 79: 106-109.

5j Kubota K, Bandai Y, Noie T, Ishizaki Y, Teruya M, Makuuchi M. How should polypoid lesions of the gallbladder be treated in the era of laparoscopic cholecystectomy? Surgery 1995; 117: 481-487.

6j Park JK, Yoon YB, Kim YT, Ryu JK, Yoon WJ, Lee SH, et al. Management strategies for gallbladder polyps: Is it possible to predict malignant gallbladder polyps? Gut and Liver 2008; 2: 88-94.

7j Kwon W, Jang JY, Lee SE, Hwang DW, Kim SW. Clinicopathologic features of polypoid lesions of the gallbladder and risk factors of gallbladder cancer. J Korean Med Sci 2009; 24: 481-487.

8j Corwin MT, Siewert B, Sheiman RG, Kane RA. Incidentally detected gallbladder polyps: Is follow-up necessary? -Long-term clinical and US analysis of 346 patients. Radiology 2011; 258: 277-282.

9j Cha BH, Hwang JH, Lee SH, Kim JE, Cho JY, Kim H, et al. Pre-operative factors that can predict neoplastic polypoid lesions of the gallbladder. World J Gastroenterol 2011; 17: 2216-2222.

10j Myers RP, Shaffer EA, Beck PL. Gallbladder polyps: epidemiology, natural history and management. Can J Gastroenterol. 2002; 16: 187-194.

11j Mainprize KS, Gould SWT, Gilbert JM. Surgical management of polypoid lesions of the gallbladder. Br J Surg. 2000; 87: 414-417.

12j Akatsu T, Aiura K, Shimazu M, et al. Can endoscopic sonography differentiate nonneoplastic from neoplastic gallbladder polyps? Dig dis Sci. 2006; 51: 416-421.

13j Sugiyama M, Atomi Y, Yamato T. Endoscopic ultrasonography for differential diagnosis of polypoid gallbladder lesions: analysis in surgical and follow up series. Gut 2000; 46: 250-254.


f’f

ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ5
’_“šŠŕ‚đ‹^‚¤—Տ°Çó‚́H

‰ŠátA‰Eă• •”’ɁA‘̏dŒ¸­‚Č‚Ç‚Ĺ‚ ‚é‚ŞA‰Šú‚Ě’iŠK‚Ĺ‚Í‚ľ‚΂ľ‚ΖłÇó‚Ĺ‚ ‚éB

„§“x‚Č‚ľ

‰đŕ
1)@’_ŠÇŠŕ

’_ŠÇŠŕ‚̏‰”­Çó‚͉Šáti84-90“jA‘̏dŒ¸­i35“jA• ’Ɂi30“jAˆŤSšq“fi12-25“jA”­”Mi10“j‚Ć‚ł‚ę‚é1, 2jBˆę•űA–{–M‚É‚¨‚Ż‚é•ń‚ł͉Šát‚Í–ń”ź”‚É‚Ć‚Ç‚Ü‚čA25“‚Ş• ’É‚Ĺ”­Ç‚ľ‚Ä‚˘‚é3jB–ł‰ŠátA–łÇó—á‚Ě”­ŒŠŒ_‹@‚ÍŠĚ‹@”\áŠQ‚Ĺ‚ ‚é4jB

2j@’_”XŠŕ

’_”XŠŕ‚̏‰”­Çó‚ɂ͉Eă• •”’Ɂi50-80%jA‰Šáti10-44%jAˆŤSšq“fi15-68%jA‘̏dŒ¸­i10-72%jAHŽv•sUi4-74%j‚Ş‚ ‚°‚ç‚ę‚é5-7jB‰Šát—á‚͐isŠŕ‚Ş‘˝‚­—\Œă•s—Ç‚Ĺ‚ ‚é‚ą‚Ć‚Ş‘˝‚˘7jBŠŕ‚Ş’_”X•Ç“ŕ‚É‚Ć‚Ç‚Ü‚é’iŠK‚Ĺ‚Í–łÇó—á‚Ş‘˝‚­AŒŸf‚Ě• •”ƒGƒR[‚â’_ÎÇ‚Ć‚ľ‚čs‚í‚ę‚˝’_”X“Eop‚É‚ć‚č‹ô‘R‚É”­ŒŠ‚ł‚ę‚é‚ą‚Ć‚Ş’m‚ç‚ę‚Ä‚˘‚é8, 9jB

3)@“ű“Ş•”Šŕ

“ű“Ş•”Šŕ‚̏‰”­Çó‚͉Šáti72-90%jA”­”MA• ’É‚Ş‘˝‚­A‚‚˘‚Ĺ‘SgŒ‘‘ÓŠ´A‘̏dŒ¸­AHŽv•sUA”w•”’É‚Č‚Ç‚Ĺ‚ ‚é10-12jB”äŠr“I—\Œă‚Ş‚ć‚˘‚Ć‚ł‚ę‚é–ł‰Šát—á‚Í• •”ƒGƒR[Aă•”Á‰ťŠÇ“ŕŽ‹‹žŒŸ¸AŠĚ‹@”\áŠQ‚Č‚Ç‚Ĺ‹ô‘R‚É”­ŒŠ‚ł‚ę‚é13, 14jB

ŽQl•śŒŁ

1j Aljiffry M, Abdulelah A, Walsh M, Peltekian K, Alwayn I, Molinari M. Evidence-based approach to cholangiocarcinoma: a systematic review of the current literature. J Am Coll Surg 2009; 208: 134-47.

2j DeOliveira ML, Cunningham SC, Cameron JL, Kamangar F, Winter JM, Lillemoe KD, et al. Cholangiocarcinoma: thirty-one-year experience with 564 patients at a single institution. Ann Surg. 2007; 245(5): 755-62.

3j Ź—ŃČŒáA‰i–ě_şA“yŠň—Sˆę˜YAXłŽ÷. yŠĚE’_“šŒnÇŒóŒQ(‘ć2 ”Ĺ)@‚ť‚Ě‘ź‚̊́E’_“šŒnŽžŠł‚đŠÜ‚߂ā@ŠĚŠO’_“š•Ňz ŠĚŠO’_ŠÇ(’_ŠÇA’_”XŠÇA‘’_ŠÇ)@Žîᇁ@ŠĚŠO’_ŠÇŒnŽîᇁi—ǐŤAˆŤŤj. “ú–{—Տ°2011; •ĘűiŠĚE’_“šŒnÇŒóŒQⅢ j; 36-40.

4j LźFA’ˇ’Jě—mAâ–{‰pŽŠAŹźrˆę˜YA“c”¨’qäA‰Ä–ڐ˝ŽĄAÂ—t‘ž˜Y. “ŕŽ‹‹ž‰şśŒŸ‚ސf’f‚É—L—p‚Ĺ‚ ‚Á‚˝–ł‰Šát‘Šú’_ŠÇŠŕ‚Ě1 —á |–{–M•ń73 —á‚ĚŒŸ“˘| Journal of Japan Biliary Association 2007; 21: 75-81.

5j Cubertafond P, Gainant A and Cucchiaro G. Surgical treatment of 724 carcinomas of the gallbladder, Results of the French surgical association survey. Annals of Surg. 1994; 3: 275-280.

6j Misra S, Chaturvedi A, Misra NC, Sharma ID. Carcinoma of the gallbladder. Lancet Oncol. 2003; 4: 167-176.

7j Konstantinidis IT, Deshpande V, Genevay M, Berger D, Fernandez-del CC, Tanabe KK, et al. Trends in presentation and survival for gallbladder cancer during a period of more than 4 decades: a single-institution experience. Arch Surg. 2009; 144: 441-7; discussion 447.

8j ŽODLŽAŠŁ˜a˜YA–F–ěƒŽĄA•ž•”šŽuAŽá—Ń‹M•vA‰œ“ˆˆę•A‘ź. ’_”XŠŕ‚Ě’´‰š”gf’f‚ĚŒť‹ľ‚Ć–â‘č“_. ŠĚ’_äX2006; 53: 201-204.

9j Albores-Saavedra J, Chable-Montero F, Angeles-Albores D, Schwartz A, Klimstra DS, Henson DE. Early gallbladder carcinoma: a clinicopathologic study of 13 cases of intramucosal carcinoma. Am J Clin Pathol 2011; 135: 637-642.

10j Winter JM, Cameron JL, Olino K, Herman JM, de JMC, Hruban RH et al. Clinicopathologic analysis of ampullary neoplasms in 450 patients: implications for surgical strategy and long-term prognosis. J Gastrointest Surg. 2010; 14: 379-387.

11j Nieveen Van Dijkum EJ, Terwee CB, Oosterveld P, Van Der Meulen JH, Gouma DJ, De Haes JC. Validation of the gastrointestinal quality of life index for patients with potentially operable periampullary carcinoma. Br J Surg. 2000; 87: 110-5.

12j Hatzaras I, George N, Muscarella P, Melvin WS, Ellison EC, Bloomston M. Predictors of Survival in Periampullary Cancers Following Pancreaticoduodenectomy. Ann Surg Oncol 2010; 17: 991-7

13j Kamisawa T, Tu Y, Egawa N, Nakajima H, Horiguchi S, Tsuruta K, et al. Clinicopathologic features of ampullary carcinoma without jaundice. J Clin Gastroenterol. 2006; 40: 162-6.

14j Yokoyama N, Shirai Y, Wakai T, Nagakura S, Akazawa K, Hatakeyama K. Jaundice at presentation heralds advanced disease and poor prognosis in patients with ampullary carcinoma. World J Surg. 2005; 29: 519-523.


ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ6
’_“šŠŕf’f‚Ěƒtƒ@[ƒXƒgƒXƒeƒbƒv‚́H

ƒtƒ@[ƒXƒgƒXƒeƒbƒv‚Í”ńNP“I‚Č• •”’´‰š”gŒŸ¸‚¨‚ć‚ŃŒŒ‰tŒŸ¸‚Ĺ‚ ‚éB

„§“x1@ƒGƒrƒfƒ“ƒXƒŒƒxƒ‹C

‰đŕ
1)@ŒŒ‰tŒŸ¸

ŠĚ’_“šŒny‘f‚̏㏸‚đ”F‚ß‚é‚Ş’_“šŠŕ‚É“ÁˆŮ“I‚Ć‚Í‚˘‚Ś‚Č‚˘B

2)@• •”’´‰š”gŒŸ¸

’_“šŠŕ‚đ‹^‚Á‚˝ę‡‚ɍŏ‰‚ɍs‚¤‚ׂŤ‰ć‘œf’f‚Í• •”’´‰š”gŒŸ¸‚Ĺ‚ ‚éB

ŠĚŠO’_ŠÇŠŕ‚̐f’f‚ÍŠ´“x89%Ałf—Ś80-90“‚Ć‚ł‚ę‚é‚é1, 2jBŽîᇕ`o—Ś‚͉ş•”’_ŠÇ‚ł͒ቺ‚ˇ‚é3j‚Şă—Ź’_ŠÇ‚ĚŠg’Ł‚Í’_ŠÇŠŕ‚đ‹^‚¤ŠÔÚŠŒŠ‚Ć‚Č‚éB

’_”XŠŕ‚Ĺ‚Í50“ˆČă‚ŞŽîᇂƂľ‚Ä•`o‚ł‚ę‚é‚Ş4jA’_”X“EopŒă‚ɏp‘Of’f‚ł‚ę‚Ä‚˘‚Č‚˘occult cancer ‚Ş0.2-5“‘śÝ‚ˇ‚é5, 6jB

“ű“Ş•”Šŕ‚Ě•`o‚Í“ď‚ľ‚˘‚ŞäXŠÇŠg’Ł‚𔺂¤’_ŠÇŠg’Łidouble-duct signj7j‚͊ԐڏŠŒŠ‚Ć‚Č‚éB‚ľ‚Š‚ľA‚ą‚̏ŠŒŠ‚ÍäX“Ş•”Šŕ‚Ĺ‚ŕ”F‚ß‚ç‚ę“ÁˆŮ“I‚Ć‚Í‚˘‚Ś‚Č‚˘B

3j@Žîᇃ}[ƒJ[

’_“šŠŕ‚É“ÁˆŮ“I‚ČŽîᇃ}[ƒJ[‚Í‚Č‚˘8, 9jB‘ź‚ĚŒŸ¸‚Ć‚Ě‘g‚ݍ‡‚í‚š‚É‚ć‚čf’f”\‚ÍŒüă‚ˇ‚é‚ŞAŽîᇃ}[ƒJ[‚É‚ć‚鑁Šúf’f‚͍˘“ď‚Ĺ‚ ‚éB

ŽQl•śŒŁ

1j Aljiffry M, Abdulelah A, Walsh M, Peltekian K, Alwayn I, Molinari M. Evidence-based approach to cholangiocarcinoma: a systematic review of the current literature. J Am Coll Surg 2009; 208: 134-47.

2j Slattery JM, Sahani DV. What is the current state-of-the-art imaging for detection and staging of cholangiocarcinoma? Oncologist. 2006; 11: 913-22.

3j Albu S, Tantau M, Sparchez Z, Branda H, Suteu T, Badea R, et al. Diagnosis and treatment of extrahepatic cholangiocarcinoma: results in a series of 124 patients. Rom J Gastroenterol. 2005; 14: 33-6.

4j de Groen PC, Gores GJ, LaRusso NF, Gunderson LL, Nagorney DM. Biliary tract cancers. N Engl J Med. 1999; 28; 341: 1368-78.

5j Silecchia G, Raparelli L, Jover Navalon JM, Gomez AS, Azcoita MM, Materia A, et al. Laparoscopic cholecystectomy and incidental carcinoma of the extrahepatic bilary tree. 2002; JSLS 6: 339-44.

6j Konstantinidis IT, Deshpande V, Genevay M, Berger D, Fernandez-del CC, Tanabe KK, et al. Trends in presentation and survival for gallbladder cancer during a period of more than 4 decades: a single-institution experience. Arch Surg. 2009; 144: 441-7; discussion 447.

7j Kim JH, Kim MJ, Chung JJ, Lee WJ, Yoo HS, Lee JT. Differential diagnosis of periampullary carcinomas at MR imaging. Radiographics. 2002; 22: 1335-1352.

8j ŠFě‹I„AŽRŒűK“ń. yŽîᇃ}[ƒJ[-‚ť‚̍Ą“ú“I‰đŽßi—‰đj‚Ɖž—pz äXŠŕE’_“šŠŕ‚ĚŽîᇃ}[ƒJ[. Źl•a‚ƐśŠˆKŠľ•a2011; 06; 41; 654-660.

9j Khan SA, Davidson BR, Goldin R, Pereira SP, Rosenberg WM, Taylor-Robinson SD et al. Guidelines for the diagnosis and treatment of cholangiocarcinoma: consensus document. Gut 2002; 51; 6: VI1-VI9.


ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ7
’_ŠÇŠŕf’f‚ĚƒZƒJƒ“ƒhƒXƒeƒbƒv‚Ć‚ľ‚Ä‚Ü‚¸s‚¤‚ׂŤŒŸ¸‚Í?

CT‚Í•a•Ď‚Ě‹ÇÝ‚¨‚ć‚ѐi“W“xf’f‚É—L—p‚Ĺ‚ ‚čA’_ŠÇŠŕf’f‚ĚƒZƒJƒ“ƒhƒXƒeƒbƒv‚Ć‚ľ‚čs‚¤Ž–‚Ş‹­‚­ŠŠ‚ß‚ç‚ę‚é.‚ť‚ĚŰ‚É‚ÍƒhƒŒƒi[ƒW‘O‚ÉŽŔŽ{‚ľA‚Č‚é‚ׂ­—ń”‚Ě‘˝‚˘MDCT ‚É‚ć‚éƒ_ƒCƒiƒ~ƒbƒNCT ‚đs‚¤Ž–‚ސ„§‚ł‚ę‚éB

„§“x1@ƒGƒrƒfƒ“ƒXƒŒƒxƒ‹B

‰đŕ

CT ‚ÍŒŸ¸‚̊ȕ֐ŤA•‹y“xAƒRƒXƒg‚Č‚Ç‚Ě‘‡“I‚ČŠĎ“_‚Š‚çA’_ŠÇŠŕf’f‚ĚƒZƒJƒ“ƒhƒXƒeƒbƒv‚Ć‚ľ‚čs‚¤‚ą‚Ć‚Ş‹­‚­„§‚ł‚ę‚錟¸‚Ĺ‚ ‚éB‚˝‚ž‚ľ’PƒCT‚ž‚Ż‚ł͐f’f”\‚Ş•s\•Ş‚Ĺ‚ ‚čA‘˘‰eCTi‰Â”\‚Ĺ‚ ‚ę‚΃_ƒCƒiƒ~ƒbƒNCTj‚Ş•K{‚Ĺ‚ ‚éBƒ_ƒCƒiƒ~ƒbƒNCT ‚Ĺ‚ÍŒŒ—Ź“Ž‘Ô‚Ě•]‰ż‚މ”\‚Ć‚Č‚é‚ž‚Ż‚Ĺ‚Č‚­A’x‰„‘Š‚ł͐üˆŰ‰ť‚Ě‹­‚˘Žîᇂ̃Rƒ“ƒgƒ‰ƒXƒg‚Ş–ž—Ä‚É‚Č‚éę‡‚Ş‚ ‚éB‚Ü‚˝MDCT ‚đŽg—p‚ˇ‚éę‡‚É‚Í‚Č‚é‚ׂ­—ń”‚Ě‘˝‚˘MDCT ‚đŽg—p‚ľAŠÇ‹…‰ń“]‚Ěƒsƒbƒ`‚âƒe[ƒuƒ‹ƒXƒs[ƒh‚đĹ“K‰ť‚ˇ‚é‚ą‚Ć‚É‚ć‚鍂‹óŠÔ•Ş‰đ”\‚Ě‰ć‘œŽűW‚ސ„§‚ł‚ę‚éB‚ą‚ę‚É‚ć‚č‘˝•űŒü‚Š‚ç‚ĚŠĎŽ@‚É‚ć‚éi“W“xf’f1j‚âA“Ž–Ź‘Š‚Ě3D ‰ťiCT Angiographyj‚É‚ć‚čŒŒŠÇZ‚Ě•]‰ż‚މ”\‚Ć‚Č‚é2, 3jB

CT ‚ĚŽŔŽ{‚̓hƒŒƒi[ƒW‘}“ü‘O‚ÉŽ{s‚ł‚ę‚é‚ą‚Ć‚Ş–]‚Ü‚ľ‚­A’_ŠÇ‚Ě‹ˇó•”‚Ě•`o‚â•Ç”ěŒú‚Ě“Ż’č‚É—L—˜‚Ĺ‚ ‚é1jB

ŽQl•śŒŁ

1j Unno M, Okumoto T, Katayose Y, Rikiyama T, Sato A, Motoi F, Oikawa M, Egawa S, Ishibashi T. Preoperative assessment of hilar cholangiocarcinoma by multidetector row computed tomography. J Hepatobiliary Pancreat Surg. 2007; 14: 434-40.

2j Endo I, Shimada H, Sugita M. Role of three-dimensional imaging in operative planning for hilar cholangiocarcinoma. Surgery. 2007 Nov; 142: 666-75.

3j Chen HW, Lai EC, Pan AZ, Chen T, Liao S, Lau WY. Preoperative assessment and staging of hilar cholangiocarcinoma with 16-multidetector computed tomography cholangiography and angiography. Hepatogastroenterology. 2009; 56: 578-83.


ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ8
’_ŠÇŠŕf’f‚ĚƒT[ƒhƒXƒeƒbƒv‚Ć‚ľ‚Ă͂ǂ̂悤‚Ȑf’f–@‚Ş‚ ‚é‚Š?

MRIiMRCP ‚đŠÜ‚ށj‚Í•a•Ď‚Ě‹ÇÝ‚¨‚ć‚ѐi“W“xf’f‚É—LŒř‚Ĺ‚ ‚éB
ERCP ‚âPTC ‚Č‚Ç‚Ě’źÚ’_“š‘˘‰e‚Í‹óŠÔ•Ş‰đ”\‚É—D‚ęA…•˝i“W‚Ȃǂ̐¸–§‚Ȑf’f‚É—LŒř‚Ĺ‚ ‚éB
’_“š‹ž‚Í”S–Œ“ŕi“W‚̐f’f‚É—D‚ęA’źŽ‹‰ş‚É’_“šă”ç‚đśŒŸ‚Ĺ‚Ť‚é—˜“_‚Ş‚ ‚éB
IDUS ‚Í’_ŠÇŠŕ‚̐[’B“xf’fAŒŒŠÇZ‚Ě•]‰żA‚ť‚ľ‚Ä•Ç“ŕi“W‚Ě•]‰ż‚É—L—p‚Ĺ‚ ‚éB
FDG-PET ‚͉“Šu“]ˆÚ‚âÄ”­‘ƒ‚Ě”­ŒŠ‚É—LŒř‚Ĺ‚ ‚éB
EUS ‚͐f’f˘“ď—á‚̐¸¸‚É—L—p‚Ĺ‚ ‚čAEUS-FNA ‚Í”ńNP“I‚Č‘gDf’f–@‚Ć‚ľ‚Ä—L—p‚Ĺ‚ ‚éB

„§“x‚Č‚ľ@ƒGƒrƒfƒ“ƒXƒŒƒxƒ‹C

‰đŕ
‚PjMRCP,MRI

MRCP ‚Í”ńNP“I‚É’_ŠÇ‚Ě‹ˇó•”ˆĘ‚Ě“Ż’č‚âi“W“x‚̐f’fAäXE’_ŠÇ‡—ŹˆŮí‚̐f’f‚މ”\‚Ĺ‚ ‚č1jA‚Ü‚˝‹ˇó‚Ě‚˝‚ß’źÚ‘˘‰e‚Ĺ‚Í•`o‚Ĺ‚Ť‚Č‚˘•ŞŽ}‚Ü‚Ĺ‰ć‘œ‰ť‚Ĺ‚Ť‚é“Á’Ľ‚đ—L‚ľA‹ô”­Ç‚ĚƒŠƒXƒN‚𔺂¤ERCP ‚âPTC ‚Č‚Ç‚Ě’źÚ‘˘‰e‚ɐ旧‚Á‚čs‚í‚ę‚é‚ׂŤŒŸ¸–@‚Ĺ‚ ‚éB‚Ü‚˝MRI ‚ÍŒŒŠÇZ‚âŠĚZ‚Ě•]‰ż‚É—D‚ę‚é‚˝‚߁AMRI ‚ĆMRCP ‚Ě‘g‚ݍ‡‚í‚š‚ޏp‘O•]‰ż‚É—L—p‚Ĺ‚ ‚é1jB

‚QjERCP,PTC,’_“š‹ž

’źÚ’_“š‘˘‰eŒŸ¸‚Í‹óŠÔ•Ş‰đ”\‚É—D‚ę‚é‚˝‚߁AŒ‹ß‚ŕ‚ľ‚­‚ÍŒ‹ßZŒ^’_ŠÇŠŕ‚̐…•˝Z”͈͂đÚ×‚ɐf’f‚ˇ‚éŰ‚É—L—p‚Ĺ‚ ‚é2jB‚Ü‚˝’_ŠÇ‹ˇó‚̐f’f”\‚É—D‚ęA—LjŤŤ‚̐łf—Ś‚ŞMRCP ‚ć‚č‚‚˘‚Ć‚Ě•ń‚ŕ‚ ‚é3jB

Œo”çŒoŠĚ’_“š‹ž; PTCSipercutaneous transhepatic cholangioscopyj‚Í’_ŠÇ“ŕo‚ĚÚ×‚ČŠĎŽ@‚Ć’źŽ‹‰ş‚̐łŠm‚ȐśŒŸ‚đ‰Â”\‚Ć‚ľA—ǐŤ’_ŠÇ‹ˇó‚Ƃ̊ӕʐf’f‚¨‚ć‚Ń’_ŠÇŠŕ‚Ě”S–Œ“ŕi“W”͈͐f’f‚É—L—p‚Ĺ‚ ‚é4-6jBŒoŒű’_“š‹ž; POCSiperoral cholangioscopyj‚ŕ’_ŠÇ‹ˇó‚Ě—ÇˆŤŤŠÓ•Ęf’f‚É—LŒř‚Ĺ‚ ‚čA×–Ef‚␜ŒŸ‚Ć‘g‚ݍ‡‚í‚š‚é‚ą‚Ć‚É‚ć‚čf’f”\‚đŒüă‚ł‚š‚é7jB

‚ľ‚Š‚ľAPTC ‚âPTCS ‚Í”dŽí‚âᑍEÄ”­‚ĚŠëŒŻŤ‚ŕ‚ ‚é‚˝‚ß8jA“K‰ž‚͐Td‚É‚ˇ‚é‚ׂŤ‚Ĺ‚ ‚éB

3jEUS, IDUS

’´‰š”g“ŕŽ‹‹ž; EUSiEndoscopic Ultrasonographyj‚ÍŠĚ–ĺ•”’_ŠÇŠŕ‚ĚŒŒŠÇZ‚â’†‰ş•”’_ŠÇ‚Ş‚ń‚Ě•Ç“ŕi“W“xf’f‚É—L—pŤ‚ލ‚‚˘9, 10jB‚Ü‚˝EUS-FNA ‚͍‚‚˘’_“šŠŕi’_”XŠŕ‚đŠÜ‚ށj‚̐f’f”\‚Ş•ń‚ł‚ę‚Ä‚¨‚č11jA“ŕŽ‹‹ž“IŽč–@‚Ĺ‘gDf’f‚Ş“ž‚ç‚ę‚Č‚Š‚Á‚˝ę‡‚ɍl—ś‚ł‚ę‚é‚ׂŤf’f–@‚Ĺ‚ ‚é12jB

’_ŠÇo“ŕ’´‰š”gŒŸ¸; IDUSiintraductal ultrasonographyj‚́A’_ŠÇŠŕ‚̐[’B“xf’fAŒŒŠÇZ‚Ȃǂ̐‚’ź•űŒüZ‚̐f’fA‚¨‚ć‚Ń•Ç“ŕi“W‚̐f’f‚É—D‚ę‚é5jB

4jPET

Ĺ‹ß‚Ĺ‚ÍCT ‚Ćˆę‘ĚŒ^‚ĚPET/CT ‚Ş•‹y‚ľAPET ę—p‹@‚ć‚č‚ŕ‚‚˘—L—pŤ‚Ş•ń‚ł‚ę‚Ä‚˘‚é13, 14jBƒŠƒ“ƒpß“]ˆÚ‚≓Šu“]ˆÚ‚ĚŒŸo‚ ‚邢‚͍Ĕ­‘ƒ‚ĚŒŸo‚đ–Ú“I‚Ć‚ˇ‚éę‡‚ɍl—ś‚ł‚ę‚é‚ׂŤf’f–@‚Ĺ‚ ‚éB

ŽQl•śŒŁ

1j Masselli G, Manfredi R, Vecchioli A, Gualdi G. MR imaging and MR cholangiopancreatography in the preoperative evaluation of hilar cholangiocarcinoma: correlation with surgical and pathologic findings. Eur Radiol. 2008 Oct; 18: 2213-21. Epub 2008 May 8.

2j Tsukada K, Takada T, Miyazaki M. Diagnosis of biliary tract and ampullary carcinomas. J Hepatobiliary Pancreat Surg. 2008; 15: 31-40. Epub 2008 Feb 16.

3j Domagk D, Wessling J, Reimer P, Hertel L, Poremba C, Senninger N, Heinecke A, Domschke W, Menzel J. Endoscopic retrograde cholangiopancreatography, intraductal ultrasonography, and magnetic resonance cholangiopancreatography in bile duct strictures: a prospective comparison of imaging diagnostics with histopathological correlation.@Am J Gastroenterol. 2004 Sep; 99: 1684-9.

4j Lee SS, Kim MH, Lee SK, Kim TK, Seo DW, Park JS, Hwang CY, Chang HS, Min YI. MR cholangiography versus cholangioscopy for evaluation of longitudinal extension of hilar cholangiocarcinoma. Gastrointest Endosc. 2002; 56: 25-32.

5j Tamada K, Ushio J, Sugano K. Endoscopic diagnosis of extrahepatic bile duct carcinoma: Advances and current limitations. World J Clin Oncol. 2011 May 10; 2: 203-16.

6j Iqbal S, Stevens PD. Cholangiopancreatoscopy for targeted biopsies of the bile and pancreatic ducts. Gastrointest Endosc Clin N Am. 2009 Oct; 19: 567-77.

7j Fukuda Y, Tsuyuguchi T, Sakai Y, Tsuchiya S, Saisyo H. Diagnostic utility of peroral cholangioscopy for various bile-duct lesions. Gastrointest Endosc. 2005 Sep; 62: 374-82.

8j Sakata J, Shirai Y, Wakai T, Nomura T, Sakata E, Hatakeyama K. Catheter tract implantation metastases associated with percutaneous biliary drainage for extrahepatic cholangiocarcinoma. World J Gastroenterol. 2005 Nov 28; 11: 7024-7.

9j Hara K, Bhatia V, Hijioka S, Mizuno N, Yamao K. A convex EUS is useful to diagnose vascular invasion of cancer, especially hepatic hilus cancer. Dig Endosc. 2011 May; 23 Suppl 1: 26-8.

10j ‹Ę“cŠěˆęA›–ěŒ’‘ž˜Y: ’_ŠÇŠŕ‚̐f’f‚ĆŽĄ—Ă. “ŕ‰Č‚Ě—§ę‚Š‚ç.“ú–{Á‰ťŠí•aŠw‰ďŽGŽ. 102; 866-872, 2005.

11j Wu LM, Jiang XX, Gu HY, Xu X, Zhang W, Lin LH, Deng X, Yin Y, Xu JR. Endoscopic ultrasound-guided fine-needle aspiration biopsy in the evaluation of bile duct strictures and gallbladder masses: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2011 Feb; 23: 113-20.

12j Ohshima Y, Yasuda I, Kawakami H, Kuwatani M, Mukai T, Iwashita T, Doi S, Nakashima M, Hirose Y, Asaka M, Moriwaki H. EUS-FNA for suspected malignant biliary strictures after negative endoscopic transpapillary brush cytology and forceps biopsy. J Gastroenterol. 2011 Jul; 46: 921-8.

13j Furukawa H, Ikuma H, Asakura-Yokoe K, Uesaka K. Preoperative staging of biliary carcinoma using 18F-fluorodeoxyglucose PET: prospective comparison with PET+CT, MDCT and histopathology. Eur Radiol. 2008 Dec; 18: 2841-7. Epub 2008 May 29.

14j Kobayashi S, Nagano H, Hoshino H, Wada H, Marubashi S, Eguchi H, Takeda Y, Tanemura M, Kim T, Shimosegawa E, Hatazawa J, Doki Y, Mori M. Diagnostic value of FDG-PET for lymph node metastasis and outcome of surgery for biliary cancer. J Surg Oncol. 2011 Mar 1; 103: 223-9. Epub 2010 Dec 7.


ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ9
’_”XŠŕf’f‚ĚƒZƒJƒ“ƒhƒXƒeƒbƒv‚Ć‚ľ‚Ä‚Ü‚¸s‚¤‚ׂŤŒŸ¸‚Í?

CT ‚Í•a•Ď‚Ě‹ÇÝf’f‚âi“W“xf’f‚É—L—p‚Ĺ‚ ‚čAƒZƒJƒ“ƒhƒXƒeƒbƒv‚Ć‚ľ‚čs‚¤Ž–‚Ş‹­‚­ŠŠ‚ß‚ç‚ę‚éB‚ť‚ĚŰ‚É‚Í‚Č‚é‚ׂ­—ń”‚Ě‘˝‚˘MDCT ‚É‚ć‚éƒ_ƒCƒiƒ~ƒbƒNCT ‚đs‚¤Ž–‚ސ„§‚ł‚ę‚éB

„§“x1@ƒGƒrƒfƒ“ƒXƒŒƒxƒ‹B

‰đŕ

CT: CT ‚Í•a•Ď‚Ě‹ÇÝf’f‚âi“W“xf’fAŒŒŠÇZAŠĚZ‚̐f’f”\‚ލ‚‚­Aresectability ‚Ě•]‰ż‚É‚ŕ—L—p‚ĹƒZƒJƒ“ƒhƒXƒeƒbƒv‚Ć‚ľ‚čs‚¤Ž–‚Ş‹­‚­ŠŠ‚ß‚ç‚ę‚éB‚ľ‚Š‚ľ’PƒCT ‚ž‚Ż‚ł͐f’f”\‚Ş•s\•Ş‚Ĺ‚ ‚čA‹ÖŠő‚âTd“Š—^—áiƒAƒŒƒ‹ƒM[—đ‚ât‹@”\áŠQ‚Ȃǁj‚É”z—ś‚ľ‚˝ă‚Ĺ‘˘‰eCT‚đs‚¤‚ׂŤ‚Ĺ‚ ‚éB‚ł‚ç‚ɉ”\‚ČŒŔ‚č‚Q‘Ši“Ž–ŹE–ĺ–Ź‘ŠjˆČă‚Ěƒ_ƒCƒiƒ~ƒbƒNCT ‚đŽŔŽ{‚ľ‚˝•ű‚Ş‚ć‚˘1jB‚Ü‚˝MDCT‚É‚ć‚鍂‹óŠÔ•Ş‰đ”\‚Ěƒf[ƒ^ŽűW‚Ş–]‚Ü‚ľ‚˘2jB

ŽQl•śŒŁ

1j Kumaran V, Gulati S, Paul B, Pande K, Sahni P, Chattopadhyay K. The role of dual-phase helical CT in assessing resectability of carcinoma of the gallbladder. @Eur Radiol. 2002 Aug; 12: 1993-9. Epub 2002 Apr 19.

2j Kim SJ, Lee JM, Lee JY, Choi JY, Kim SH, Han JK, Choi BI. Accuracy of preoperative T-staging of gallbladder carcinoma using MDCT. AJR Am J Roentgenol. 2008 Jan; 190: 74-80.


ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ10
’_”XŠŕf’f‚ĚƒT[ƒhƒXƒeƒbƒv‚Ć‚ľ‚Ă͂ǂ̂悤‚Ȑf’f–@‚Ş‚ ‚é‚Š?

EUSAMRIiMRCP‚đŠÜ‚ށj‚âERCPA‚ ‚邢‚ÍERCP ŠÖ˜AŽč‹Z‚Í•a•Ď‚Ě‹ÇÝf’fAŽż“If’f‚âi“W“xf’f‚É—L—p‚Ĺ‚ ‚é‚ŞAf’f”\‚ÉŠÖ‚ľ‚Ä‚ÍŠeX‚ĚŒŸ¸–@‚ĹˆŮ‚Č‚éBPET ‚͉“Šu“]ˆÚ‚âÄ”­‘ƒ‚Ě”­ŒŠ‚É—L—p‚Ĺ‚ ‚éB

„§“x‚Č‚ľ@ƒGƒrƒfƒ“ƒXƒŒƒxƒ‹C

‰đŕ

EUS: EUS ‚ÍUS ‚É”äŠr‚ľ‚Ä’_”X—˛‹NŤ•a•Ď‚̐f’f”\‚É—D‚ę‚Ä‚˘‚é1jB‚Ü‚˝AMDCT ‚Ć”äŠr‚ľ‚Ä‚ŕ’_”X“ŕ—˛‹NŤ•a•Ď‚ĚŠ´“x‚ÍEUS ‚Ş—D‚ę‚Ä‚˘‚é‚Ć‚Ě•ń‚Ş‚ ‚éBˆę•űA1cm ˆČ‰ş‚̏Ź•a•Ď‚É‚¨‚˘‚Ä‚ÍEUS‚É‚¨‚˘‚Ä‚ŕ—LjŤŤ‚ĚŠÓ•Ę‚Í˘“ď‚Ĺ‚ ‚é2jB’_”XŠŕ‚̐[’B“xf’f‚É‚¨‚˘‚Ä‚ŕMDCT ‚É”äŠr‚ľEUS ‚Ş—D‚ę‚Ä‚˘‚é‚Ć‚ł‚ę‚é3jB

MRI, MRCP: MRCP ‚Í”ńNP“I‚É’_”XŠÇ‚⑍ŠĚŠÇ‚ւ̐Z‚Ş•]‰ż‚Ĺ‚Ť4, 5jA‘˘‰eƒ_ƒCƒiƒ~ƒbƒNMRI ‚Í’źÚŠĚZ‚⌌ŠÇZ‚Ě•]‰ż‚É—L—p‚Ĺ‚ ‚é5jBŠĚ•a•Ď‚ĚŒŸo‚É‚ÍŠĚ“ÁˆŮŤ‘˘‰eÜ‚ĚEOB-DTPA ‚Ş—D‚ę‚Ä‚˘‚é‚Ć‚˘‚¤•ń‚ŕ‚ ‚é6jB‚ť‚Ě‘ź‚ɁAäXE’_ŠÇ‡—ŹˆŮí7j‚â’_”XŠŕ—ŢŽ—‚̏ŠŒŠ‚đ’悡‚é’_”X‘B‹ŘŽîÇ‚̐f’f8j‚É‚ŕ—L—p‚Č‚ą‚Ć‚Ş‚ ‚éiƒGƒrƒfƒ“ƒXƒŒƒxƒ‹CjB

ERCPAPOCS: ’źÚ‘˘‰e‚â’_ŠÇ”S–Œ‚Ě“ŕŽ‹‹žŠĎŽ@‚É‚ć‚čA’_”XŠÇ‚Č‚ç‚Ń‚É‘ŠĚŠÇ‚ւ̐Z‚Ě•]‰ż‚É—L—p‚Ĺ‚ ‚é9, 10jB‚Ü‚˝A—źŒŸ¸–@‚Í’_”X’_`×–Ef11j‚â“ŕŽ‹‹ž’źŽ‹‰şśŒŸ10j‚މ”\‚Ĺ‚ ‚čA’_”X•a•Ď‚â’_”XŠŕ‚É‚ć‚é’_“š‹ˇó‚ĚŠÓ•Ę‚É—L—p‚Ĺ‚ ‚éB

PET: Œ´”­‘ƒ‚̐f’f‚É‚¨‚˘‚Ä‚ÍPET/CT‚ĆMDCT ‚Í“Ż“™‚Ĺ‚ ‚é‚ŞAƒŠƒ“ƒpß“]ˆÚ‚̐f’f‚Ĺ‚ÍPET/CT ‚Ş—D‚ę‚Ä‚˘‚é‚Ć‚Ě•ń‚Ş‚ ‚é12, 13jB‚Ü‚˝‰“Šu“]ˆÚ‚̐f’f‚ÉMDCT ‚ć‚č‚ŕ—D‚ę‚Ä‚¨‚čAresectability ‚Ě•]‰ż‚É—L—p‚Ĺ‚ ‚é12, 13jB‚ł‚ç‚ɏ]—ˆ‚Ě‰ć‘œf’f–@‚É”äŠr‚ľ‚čĔ­f’f‚É‚ŕ—D‚ę‚é‚Ć•ń‚ł‚ę‚Ä‚˘‚é14, 15jB

ŽQl•śŒŁ

1j Azuma T, Yoshikawa T, Araida T, Takasaki K. Differential diagnosis of polypoid lesions of the gallbladder by endoscopic ultrasonography. Am J Surg. 2001 Jan; 181: 65-70.

2j Cheon YK, Cho WY, Lee TH, Cho YD, Moon JH, Lee JS, Shim CS. Endoscopic ultrasonography does not differentiate neoplastic from non-neoplastic small gallbladder polyps. World J Gastroenterol. 2009 May 21; 15: 2361-6.

3j Jang JY, Kim SW, Lee SE, Hwang DW, Kim EJ, Lee JY, Kim SJ, Ryu JK, Kim YT. Differential diagnostic and staging accuracies of high resolution ultrasonography, endoscopic ultrasonography, and multidetector computed tomography for gallbladder polypoid lesions and gallbladder cancer. Ann Surg. 2009 Dec; 250: 943-9.

4j Schwartz LH, Lefkowitz RA, Panicek DM, Coakley FV, Jarnagin W, Dematteo R, Fong Y, Blumgart L. Breath-hold magnetic resonance cholangiopancreatography in the evaluation of malignant pancreaticobiliary obstruction. J Comput Assist Tomogr. 2003 May-Jun; 27: 307-14.

5j Kim JH, Kim TK, Eun HW, Kim BS, Lee MG, Kim PN, Ha HK. Preoperative evaluation of gallbladder carcinoma: efficacy of combined use of MR imaging, MR cholangiography, and contrast-enhanced dual-phase three-dimensional MR angiography. J Magn Reson Imaging. 2002 Dec; 16: 676-84.

6j Vogl TJ, Kümmel S, Hammerstingl R, Schellenbeck M, Schumacher G, Balzer T, Schwarz W, Müller PK, Bechstein WO, Mack MG, Söllner O, Felix R. Liver tumors: comparison of MR imaging with Gd-EOB-DTPA and Gd-DTPA. Radiology. 1996 Jul; 200: 59-67.

7j Takuma K, Kamisawa T, Tabata T, Hara S, Kuruma S, Inaba Y, Kurata M, Honda G, Tsuruta K, Horiguchi S, Igarashi Y. Importance of early diagnosis of pancreaticobiliary maljunction without biliary dilatation. World J Gastroenterol. 2012 Jul 14; 18: 3409-14.

8j Haradome H, Ichikawa T, Sou H, Yoshikawa T, Nakamura A, Araki T, Hachiya J. The pearl necklace sign: an imaging sign of adenomyomatosis of the gallbladder at MR cholangiopancreatography. Radiology. 2003 Apr; 227: 80-8. Epub 2003 Feb 11.

9j Tsukada K, Takada T, Miyazaki M. Diagnosis of biliary tract and ampullary carcinomas. J Hepatobiliary Pancreat Surg. 2008; 15: 31-40.

10j Ramchandani M, Reddy DN, Gupta R, Lakhtakia S, Tandan M, Darisetty S, Sekaran A, Rao GV. Role of single-operator peroral cholangioscopy in the diagnosis of indeterminate biliary lesions: a single-center, prospective study. Gastrointest Endosc. 2011 Sep; 74: 511-9.

11j Itoi T, Sofuni A, Itokawa F, Kurihara T, Tsuchiya T, Moriyasu F, Yamagishi T, Serizawa H. Preoperative diagnosis and management of thick-walled gallbladder based on bile cytology obtained by endoscopic transpapillary gallbladder drainage tube. Gastrointest Endosc. 2006 Oct; 64: 512-9.

12j Lee SW, Kim HJ, Park JH, Park DI, Cho YK, Sohn CI, Jeon WK, Kim BI.Clinical usefulness of 18F-FDG PET-CT for patients with gallbladder cancer and cholangiocarcinoma. J Gastroenterol. 2010 May; 45: 560-6.

13j Kim JY, Kim MH, Lee TY, Hwang CY, Kim JS, Yun SC, Lee SS, Seo DW, Lee SK. Clinical role of 18F-FDG PET-CT in suspected and potentially operable cholangiocarcinoma: a prospective study compared with conventional imaging. Am J Gastroenterol. 2008 May; 103: 1145-51.

14j Kitajima K, Murakami K, Kanegae K, Tamaki N, Kaneta T, Fukuda H, Nakajima K. Clinical impact of whole body FDG-PET for recurrent biliary cancer: a multicenter Study. Ann Nucl Med. 2009 Oct; 23: 709-15.

15j Kumar R, Sharma P, Kumari A, Halanaik D, Malhotra A. Role of 18F-FDG PET/CT in detecting recurrent gallbladder carcinoma. Clin Nucl Med. 2012 May; 37: 431-5.


ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ11
“ű“Ş•”Šŕf’f‚ĚƒZƒJƒ“ƒhƒXƒeƒbƒv‚Ć‚ľ‚Ä‚Ü‚¸s‚¤‚ׂŤŒŸ¸‚Í?

ă•”Á‰ťŠÇ“ŕŽ‹‹žŒŸ¸‚đs‚˘AŽîᇂދ^‚í‚ę‚˝ę‡A‘gDśŒŸ‚đs‚Č‚¤B

„§“x1@ƒGƒrƒfƒ“ƒXƒŒƒxƒ‹C

‰đŕ

“ű“Ş•”Šŕ‚Í“÷Šá“IŒ`‘Ô‚Š‚çŽîᎌ^AŹÝŒ^A’×ᇌ^A‚ť‚Ě‘źiłíŒ^Aƒ|ƒŠ[ƒvŒ^A“ÁŽęŒ^j‚É•Ş—Ţ‚ł‚ę‚é1jB‘O‚RŽŇ‚¨‚ć‚Ńƒ|ƒŠ[ƒvŒ^‚Í“ŕŽ‹‹ž‘œ‚Š‚ç‹­‚­‹^f‚đŽ‚Â‚ą‚Ć‚Ş‚Ĺ‚ŤAˆř‚Ť‘ą‚ŤśŒŸ‚đs‚Č‚¤‚ą‚Ć‚É‚ć‚č‘gDf’f‚đ“ž‚éBłíŒ^‚Ĺ‚Í“ŕŽ‹‹ž“I“ű“ŞŘŠJpŒă‚ɐśŒŸ‚đs‚Č‚¤‚ą‚Ć‚É‚ć‚čf’f‚đŠm’股‚éB

śŒŸŢ—ż‚Ĺ‘BŽî‚Ɛf’f‚ł‚ę‚Ä‚ŕŘœ•W–{‚Ĺ‚ÍŠŕ‚Ş‘śÝ‚ˇ‚éę‡‚ŕ’ż‚ľ‚­‚Č‚˘‚˝‚ß2jA‘BŽî‚஡—Ă‘ÎŰ‚Ć‚Č‚éB

ŽQl•śŒŁ

1j “ú–{ŠĚ’_äXŠO‰ČŠw‰ď•Ň. —Տ°E•a—’_“šŠŕŽćˆľ‚˘‹K–ń. ‹ŕŒ´o”ŁA2013A“Œ‹ž.

2j Yamaguchi K, Enjoji M, Kitamura K. Endoscopic biopsy has limited accuracy in diagnosis of ampullary tumors. Gastrointest Endosc 1990; 36: 588-592.


ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ12
“ű“Ş•”Šŕf’f‚ĚƒT[ƒhƒXƒeƒbƒv‚Ć‚ľ‚Ă͂ǂ̂悤‚Ȑf’f–@‚Ş‚ ‚é‚Š?

‰“Šu“]ˆÚ‚⃊ƒ“ƒpß“]ˆÚ‚̐f’f‚ɁACTAMRI ‚Č‚Ç‚đs‚Č‚¤B
äXZ‚â\“ńŽw’°Z‚̐f’f‚ÉEUS ‚âIDUS ‚Ě—L—pŤ‚ŞŠú‘Ň‚Ĺ‚Ť‚éB

„§“x‚Č‚ľ@ƒGƒrƒfƒ“ƒXƒŒƒxƒ‹C

‰đŕ

‚Ü‚¸”ńŘœ‚Ě——R‚Ć‚Č‚č“ž‚鉓Šu“]ˆÚ‚⍂“x‚ĚƒŠƒ“ƒpß“]ˆÚ‚Ě—L–ł‚đŠm”F‚ˇ‚éB

ŠĚ“]ˆÚ‚Ȃǂ̉“Šu“]ˆÚ‚̐f’f‚Í• •”’´‰š”gŒŸ¸ACTAMRI ‚Č‚Ç‚Ĺs‚Č‚¤1-4jB

‰“Šu“]ˆÚ‚⃊ƒ“ƒpß“]ˆÚ‚Ş”Ű’č‚ł‚ę‚˝ę‡A‹ÇŠi“W“xf’f‚đs‚¤B• •”’´‰š”gŒŸ¸ACT ‚Ĺ‚ÍŽîᇂ̕`o‚͍˘“ď‚Čę‡‚Ş‘˝‚­AEUS ‚ ‚邢‚ÍIDUS ‚Ĺ‚Í‚ą‚ę‚đ‚ć‚­•`o‚Ĺ‚Ť‚é5-10jBEUS ‚ÍäXZ‚Ě”ť’č‚É—D‚ę‚Ä‚˘‚é‚ŞA‘gDŠw“IäX‘ŸZpanc1a ‚Ě”ť’č‚͍˘“ď‚Ĺ‚ ‚éB‚Ü‚˝A‘gDŠw“I\“ńŽw’°Zdu1 ‚ŕ”ť’荢“ď‚Ĺ‚ ‚é‚Ć‚Ě•ń‚Ş‘˝‚˘ˆę•űAŒŒŠÇZ‚ÉŠÖ‚ˇ‚銴“x‚͍‚‚˘‚Ć•ń‚ł‚ę‚Ä‚˘‚é10jBIDUS ‚ÍäXŠÇ‚â’_ŠÇ“ŕ‚ւ̐i“W‚̐f’fAäXZA\“ńŽw’°Z‚̐f’f‚É—D‚ęA80|90%‚̐łf—Ś‚Ş•ń‚ł‚ę‚Ä‚˘‚éB

ŽîᇑSśŒŸ‚ĚŽč’i‚Ć‚ľ‚Ä“ŕŽ‹‹ž“I“ű“ŞŘœp‚ĚˆÓ‹`‚đ•]‰ż‚ˇ‚éˆÓŒŠ‚Ş‚ ‚é11jB“ŕŽ‹‹ž“I“ű“ŞŘœp‚đ—p‚˘‚˝‘SśŒŸ‚É‚ć‚č•a•Ď‘S‘Ě‚đŒŸ“˘‚ľ‚˝‚¤‚Ś‚ŁAĹI“I‚Ȑf—Ă•űj‚đŒˆ’č‚ˇ‚é‚Ć‚˘‚¤—§ę‚Ĺ‚ ‚éB

ŽQl•śŒŁ

1j ’–ŽëŒ÷ˆâA‹Tˆä@–žA˛“Ą‰hˆęA‚–ě_ˆęAóŒ´VŒáA‘źB’_“šŠŕ‚É‚¨‚Ż‚é‚RD-CT ‰ć‘œ. ’_‚ĆäX2001; 22: 1097-1105.

2j Mortele JK, Ji H, Ros PR. CT and magnetic resonance imaging in pancreatic and biliary tract malignancies. Gastrointest Endosc 2002; 56: 206-212.

3j Andersson M, Kostic S, Johansson M, Lundell L, Asztély M, Hellström M. MRI combined with MR cholangiopancreatography versus helical CT in the evaluation of patients with suspected periampullary tumors: a prospective comparative study. Acta Radiol. 2005; 46: 16-27.

4j Miyakawa S, Ishihara S, Takada T, Miyazaki M, Tsukada K, et al. Flowcharts for the management of biliary tract and ampullary carcinomas. J Hepatobiliary Pancreat Surg 2008; 15: 7-14.

5j Ito K, Fujita N, Noda Y, Kobayashi G, Obana T, Horaguchi J, et al. Impact of technical modification of endoscopic papillectomy for ampullary neoplasm on the occurrence of complications. Dig Endosc 2012; 24: 30-35.

6j Menzel J, Hoepfftner N, Sulkowski U, Reimer P, Heinecke A, et al. Polypoid tumors of the major duodenal papilla: preoperative staging with intraductal US, EUS, and CT\a prospective, histopathologically controlled study. Gastrointest Endosc 1999; 49: 349-357.

7j Itoh A, Goto H, Naitoh Y, Hirooka Y, Furukawa T, et al. Intraductal ultrasonography in diagnosing tumor extension of cancer of the papilla of Vater. Gastrointest Endosc 1997; 45: 251-260.

8j ŽODLŽAŠŁ@˜a˜YA–F–ěƒŽĄAŽá—Ń‹M•vA‰œ“ˆˆę•A‘źB×Œa’´‰š”gƒvƒ[ƒu‚É‚ć‚é“ű“Ş•”Šŕ‚̐i“W“xf’fB’_‚ĆäX2003; 24: 15-20.

9j Ito K, Fujita N, Noda Y, Kobayashi G, Horaguchi J, et al. Preoperative evaluation of ampullary neoplasm with EUS and transpapillary intraductal US: a prospective and histopathologically controlled study. Gastrointest Endosc 2007; 66: 740-7.

10j Puli SR, Singh S, Hagedorn CH, Reddy J, Olyaee M. Diagnostic accuracy of EUS for vascular invasion in pancreatic and periampullary cancers: a meta-analysis and systematic review. Gastrointest Endosc 2007; 65: 788-97.

11j Yamaguchi K, Enjoji M, Kitamura K. Endoscopic biopsy has limited accuracy in diagnosis of ampullary tumors. Gastrointest Endosc 1990; 36: 588-592.


ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ13
’_”XA’_ŠÇŠŕ‚Ş‹^‚í‚ę‚éÇ—á‚ĚŽĄ—Ă‘OśŒŸE×–Ef‚Í—L—p‚ŠH

Řœ•s”\’_“šŠŕ‚Ɛf’f‚ł‚ęRŠŕŽĄ—Ă‚đŠJŽn‚ˇ‚éŰ‚ɂ́A×–EfE‘gDf‚É‚ć‚é•a—f’f‚Ş‹­‚­ŠŠ‚ß‚ç‚ę‚éB
Řœ‰Â”\’_ŠÇŠŕ‚Ş‹^‚í‚ę‚˝ę‡‚ɂ͍זEfE‘gDf‚É‚ć‚鎥—Ă‘O•a—f’f‚Ş‹­‚­ŠŠ‚ß‚ç‚ę‚éB

„§“x1@ƒGƒrƒfƒ“ƒXƒŒƒxƒ‹C

‰đŕ

’_“šŠŕ‚ĚŽĄ—Ă‘OśŒŸE×–Ef‚Ě•ű–@‚Ć‚ľ‚ẮAERCP ‰ş‚ĚŒo“ű“Ş“I’_`×–EfEŽC‰ß×–EfEççŽqśŒŸi‘gDfjAEUS ƒKƒCƒh‰ş×–EfE‘gDfAPTBDEPTCS ‰ş’_`×–EfEççŽqśŒŸi‘gDfjA‚ť‚Ě‘ź‚É• •”’´‰š”gŒŸ¸/CT ƒKƒCƒh‰ş×–EfE‘gDf‚Č‚Ç‚Ş‚ ‚éB

’_“š‹ˇóÇ—á‚Ĺ‚ĚERCP ‰ş‚ĚŒo“ű“Ş“Iƒuƒ‰ƒbƒVƒ“ƒO×–Ef‚̐ŹŃ‚ÍŠ´“x30-88“A“ÁˆŮ“x100“‚Ć•ń‚ł‚ę‚Ä‚¨‚č1jAŽ{Ý‚É‚ć‚芴“x‚É‘ĺ‚Ť‚Ȃ΂ç‚‚Ť‚Ş‚ ‚éB

EUS-FNA ‚É‚ć‚é’_”XE’_ŠÇ•a•Ď‚Ĺ‚Ě×–EfE‘gDf‚̐ŹŃ‚͗ǍD‚ō‡•šÇ‚Í”F‚ß‚Č‚Š‚Á‚˝‚Ć‚Ě•ń‚Ş‚ ‚é2jB•a•ĎŽüˆÍ‚ĚƒŠƒ“ƒpß‚ȂǁA•aŠúf’f‚⎥—Ă•űj‚ĚŒˆ’č‚É—L—p‚Ĺ‚ ‚é3, 4jB‚Ü‚˝AERCP ‰ş×–EfE‘gDf‚ĹŽż“If’f‚Ş“ž‚ç‚ę‚Č‚Š‚Á‚˝Ç—á‚ɑ΂ˇ‚éEUS-FNA ‚ŕ•â•“If’f–@‚Ć‚ľ‚Ä—L—p‚Ĺ‚ ‚é5-8jB’A‚ľAEUS-FNA ‚É‚ć‚é’_”X’_`‹zˆř‚͍‚—Ś‚É’_`˜Ro‚É‚ć‚é’_`Ť• –Œ‰Š‚đŽä‹N‚ˇ‚é‚Ć‚Ě•ń‚Ş‚ ‚č9jAEUS-FNA ‚É‚ć‚é’_”X‚â’_ŠÇ‚Š‚ç‚Ě’_`×–Ef‚͍s‚¤‚ׂŤ‚Ĺ‚Í‚Č‚˘B

’_ŠÇ‹ˇó‚ɑ΂ˇ‚éPTBD ‚ĚŒo˜H‚đ—p‚˘‚˝‘gDf‚Ć×–Ef‚́APTBD ‚ލs‚í‚ę‚˝Ç—á‚Ĺ‚ÍŽŽ‚Ý‚Ä‚ŕ—Ç‚˘•ű–@‚Ĺ‚ ‚é‚ŞAƒJƒe[ƒeƒ‹‚ĚŒo˜H‚ɉˆ‚Á‚˝Ä”­‚Ş5-6% ‚ÉŒŠ‚ç‚ę‚˝‚Ć‚Ě•ń‚Ş‚ ‚č10, 11jA‘gDf‚â×–Ef‚đ–Ú“I‚Ć‚ľ‚˝PTBD ‚Í”đ‚Ż‚é‚ׂŤ‚Ĺ‚ ‚éB

ˆČă‚̂悤‚ɁA’_“šŠŕ‚Ş‹^‚í‚ę‚˝Ç—á‚Ĺ‚Í”ńŽčp“I‚Č•ű–@‚ɂč‚—Ś‚Š‚ˆŔ‘S‚ɍזEfE‘gDf‚É‚ć‚é•a—f’f‚މ”\‚Ĺ‚ ‚é‚ą‚Ć‚Č‚Ç‚Š‚çŘœ•s”\’_“šŠŕ‚Ɛf’f‚ł‚ęA‚Š‚‰ťŠw—Ă–@A‚ ‚邢‚͉ťŠw•úŽËü—Ă–@‚đŠJŽn‚ˇ‚éŰ‚É‚ÍEUS-FNAA‚ ‚邢‚ÍŽ{Ý‚É‚ć‚Á‚Ä‚ÍŒo“ű“Ş“I‚Č×–EfE‘gDf‚É‚ć‚é‚Ş‚ń‚Ě‘gDŠw“IŞ‹’‚đ“ž‚é‚ą‚Ć‚Ş‹­‚­ŠŠ‚ß‚ç‚ę‚éB

ˆę•űAŘœ‰Â”\’_ŠÇŠŕ‚Ş‹^‚í‚ę‚˝ę‡‚É‚Í10“‹­‚ĚÇ—á‚ŗǐŤ‚Ĺ‚ ‚Á‚˝‚Ć‚Ě•ń12j‚ŞŒŠ‚ç‚ę‚é‚ą‚Ć‚Š‚ç,ŽčpNP‚Ě‘ĺ‚Ť‚Čę‡‚É‚ÍŽĄ—Ă‘O‚ÉŠŕ‚ĚŠm’čf’f‚đ“ž‚Ä‚¨‚­‚ą‚Ć‚Ş‹­‚­ŠŠ‚ß‚ç‚ę‚éB

’A‚ľAˆČă‚Ě•ű–@‚đ‚ŕ‚Á‚Ä‚ľ‚Ä‚ŕ×–EfE‘gDf‚Ě‹U‰AŤ—á‚Şˆę‚Ě’ö“x‚ ‚čA—Տ°ŠŒŠă‚ĹŠŕ‚Ş”Ű’č‚Ĺ‚Ť‚Č‚˘‚Ć‚Ť‚ɂ͎厥ˆăAŠłŽŇE‰Ć‘°ŠÔ‚ŏ\•Ş‚Č˜b‚ľ‡‚˘‚đŽ‚żAŽčp‚ ‚邢‚ÍŒľd‚ČŒo‰ßŠĎŽ@‚đs‚¤‚ׂŤ‚Ĺ‚ ‚éB

ŽQl•śŒŁ

1j Selvaggi SM .Biliary brushing cytology. Cytopathology. 2004 Apr; 15: 74-9.

2j Wu LM, Jiang XX, Gu HY, Xu X, Zhang W, Lin LH, Deng X, Yin Y, Xu JR Endoscopic ultrasound-guided fine-needle aspiration biopsy in the evaluation of bile duct strictures and gallbladder masses: a systematic review and meta-analysis.. Eur J Gastroenterol Hepatol. 2011 Feb; 23: 113-20.

3j Hijioka S, Hara K, Mizuno N, Imaoka H, Ogura T, Haba S, Mekky MA, Bhatia V, Hosoda W, Yatabe Y, Shimizu Y, Niwa Y, Tajika M, Kondo S, Tanaka T, Tamada K, Yamao K. Diagnostic yield of endoscopic retrograde cholangiography and of EUS-guided fine needle aspiration sampling in gallbladder carcinomas. J Hepatobiliary Pancreat Sci. 2011 Nov 30. (Epub ahead of print)

4j Gleeson FC, Rajan E, Levy MJ, Clain JE, Topazian MD, Harewood GC, Papachristou GI, Takahashi N, Rosen CB, Gores GJ. EUS-guided FNA of regional lymph nodes in patients with unresectable hilar cholangiocarcinoma. Gastrointest Endosc. 2008 Mar; 67: 438-43. Epub 2007 Dec 3.

5j Fritscher-Ravens A, Broering DC, Knoefel WT, Rogiers X, Swain P, Thonke F, Bobrowski C, Topalidis T, Soehendra N. Am J Gastroenterol. 2004 Jan; 99: 45-51. EUS-guided fine-needle aspiration of suspected hilar cholangiocarcinoma in potentially operable patients with negative brush cytology.

6j Lee JH, Salem R, Aslanian H, Chacho M, Topazian M. Endoscopic ultrasound and fine-needle aspiration of unexplained bile duct strictures. Am J Gastroenterol. 2004 Jun; 99: 1069-73.

7j DeWitt J, Misra VL, Leblanc JK, McHenry L, Sherman S. EUS-FNA for suspected malignant biliary strictures after negative endoscopic transpapillary brush cytology and forceps biopsy. Gastrointest Endosc. 2006 Sep; 64: 325-33.

8j Ohshima Y, Yasuda I, Kawakami H, Kuwatani M, Mukai T, Iwashita T, Doi S, Nakashima M, Hirose Y, Asaka M, Moriwaki H. EUS-guided FNA of proximal biliary strictures after negative ERCP brush cytology results. J Gastroenterol. 2011 Jul; 46: 921-8. Epub 2011 Apr 28.

9j Jacobson BC, Waxman I, Parmar K, Kauffman JM, Clarke GA, Van Dam J.@Endoscopic ultrasound-guided gallbladder bile aspiration in idiopathic pancreatitis carries a significant risk of bile peritonitis. Pancreatology. 2002; 2: 26-9.

10j Takahashi Y , Nagino M, Nishio H, Ebata T, Igami T, Nimura Y Percutaneous transhepatic biliary drainage catheter tract recurrence in cholangiocarcinoma.Br J Surg. 2010 Dec; 97: 1860-6. doi: 10.1002/bjs.7228. Epub 2010 Aug 26.

11j Sakata J, Shirai Y, Wakai T, Nomura T, Sakata E, Hatakeyama K. Catheter tract implantation metastases associated with percutaneous biliary drainage for extrahepatic cholangiocarcinoma. World J Gastroenterol. 2005 Nov 28; 11: 7024-7.

12j Nakayama A. Proximal bile duct stricture disguised as malignant neoplasm. Surgery. 1999; 125: 514-2.


’_“šƒhƒŒƒi[ƒW

ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ14
‰Šát‚đ—L‚ˇ‚銳ŽŇ‚ɏp‘O’_“šƒhƒŒƒi[ƒW‚Í•K—v‚ŠH

L”ͩ̐؏œp‚đ—\’股‚é’_“šŠŕ‚Ĺ‚Íp‘OŒ¸‰Šp‚đŽ{s‚ˇ‚éB

„§“x1@ƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ci’A‚ľL”ÍˆÍŠĚŘœÇ—á‚ÉŒŔ’股‚éj

‰đŕ

ŠĚ–ĺEă•”’_ŠÇ‚É•ÂÇ‚đ‚Ť‚˝‚ľ‚˝’_“šŠŕ‚Ě•W€“IŠO‰ČŽĄ—Ă‚ÍL”ͩ̐؏œp‚𔺂¤’_ŠÇŘœ‚Ĺ‚ ‚é‚ŞA‚ť‚̏pŒă‡•šÇ—Ś‚⎀–S—Ś‚͈ˑR‚‚­ApŒă‚ĚŽ€ˆö‚Ć‚ľ‚ÄŠĚ•s‘S‚ŞĹ‚ŕ‘˝‚˘B‚ť‚Ě‚˝‚ߏp‘O‚ĚŽcŠĚ‹@”\ˆŰŽE‹­‰ť‚đ–Ú“I‚Ć‚ľ‚˝‰ˇ‘śŠĚ‚Ě’_ŠÇƒhƒŒƒi[ƒW‚âŘœŠĚ‚Ě–ĺ–ŹÇđp‚ޏd—vŽ‹‚ł‚ę‚Ä‚˘‚éB‚ľ‚Š‚ľA‰˘•Ä‚Ĺ‚ÍˆČ‘O‚ć‚čp‘OŒ¸‰Š‚đ•s—v‚Ć‚ˇ‚él‚Ś‚ލދ­‚­‚ ‚é‚Ş1jA‚ą‚ę‚ç‚Ě•ń‚Ĺ‚ÍŠĚŘœ—á‚ĚŠ„‡‚Ş’á‚˘AŒ¸‰Š•ű–@‚ވę’č‚ľ‚Ä‚˘‚Č‚˘‚Ć‚˘‚Á‚˝–â‘č‚Ş‚ ‚čA‚ť‚Ě‚Ü‚ÜŽó‚Ż“ü‚ę‚é‚ą‚Ć‚Í˘“ď‚Ĺ‚ ‚éBŽŔŰ‚É‘˝‚­‚Ěhigh volume center ‚Ĺ‚ÍL”ͩ̐؏œ‚đ—v‚ˇ‚é’_“šŠŕ‚Ĺ‚Íp‘OŒ¸‰Šp‚ŞŽ{s‚ł‚ę‚Ä‚˘‚é2-6jB‚ą‚ę‚ç‚Ě”wŒi‚đ“Ľ‚Ü‚Ś‚˝ă‚Őę–ĺˆĎˆő‚É‚ć‚錟“˘‚ލs‚í‚ęAL”ͩ̐؏œ—\’čÇ—á‚ɑ΂ˇ‚錸‰Šp‚đ„§“x1 ‚Ć‚ˇ‚é‚ą‚Ć‚ĹŒŠ‰đ‚ވę’v‚ľ‚˝B

ŽQl•śŒŁ

1j Liu F, Li Y, Wei Y, Li B. Preoperative Biliary Drainage Before Resection for Hilar Cholangiocarcinoma: Whether or Not? A Systematic Review. Dig Dis Sci. 2011; 56: 663-672.

2j Hemming AW, Mekeel K, Khanna A, Baquerizo A, Kim RD. Portal vein resection in management of hilar cholangiocarcinoma. J Am Coll Surg. 2011; 212: 604-613.

3j Lee SG, Song GW, Hwang S, Ha TY, Moon DB, Jung DH, Kim KH, Ahn CS, Kim MH, Lee SK, Sung KB, Ko GY. Surgical treatment of hilar cholangiocarcinoma in the newera: the Asan experience. J Hepatobiliary Pancreat Sci. 2010; 17: 476-489.

4j Neuhaus P, Thelen A, Jonas S, Puhl G, Denecke T, Veltzke-Schlieker W, SeehoferD. Oncological superiority of hilar en bloc resection for the treatment of hilarcholangiocarcinoma. Ann Surg Oncol. 2012; 19: 1602-1608.

5j Igami T, Nishio H, Ebata T, Yokoyama Y, Sugawara G, Nimura Y, Nagino M. Surgical treatment of hilar cholangiocarcinoma in the "new era": the Nagoya University experience. J Hepatobiliary Pancreat Sci. 2010; 17: 449-454.

6j Iacono C, Ruzzenente A, Campagnaro T, Bortolasi L, Valdegamberi A, Guglielmi A. Role of preoperative biliary drainage in jaundiced patients who are candidates for pancreatoduodenectomy or hepatic resection: highlights and drawbacks. Ann Surg. 2013; 257: 191-204.


ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ15
p‘O’_“šƒhƒŒƒi[ƒW‚Ě“KŘ‚Č•ű–@‚͉˝‚ŠA‚Ü‚˝‚˘‚s‚¤‚ׂŤ‚ŠH

Œo”ç“IŒo˜H‚É‚ć‚éƒhƒŒƒi[ƒW‚ɂ͐úŽh‚É‚Ć‚ŕ‚Č‚¤“Á—L‚̍‡•šÇ”­ś‚̉”\Ť‚Ş‚ ‚čA“ŕŽ‹‹ž“IiŒo“ű“Ş“IjŒ¸‰Šˆ’u‚Ş‘ć1‘I‘đ‚Ć‚ľ‚Đ„§‚ł‚ę‚éB
ƒhƒŒƒi[ƒW‚Í‹Ů‹}Žž‚đœ‚˘‚ÄMDCT ‚ĚŒă‚ɍs‚í‚ę‚é‚ׂŤ‚Ĺ‚ ‚éB

„§“x2@ƒGƒrƒfƒ“ƒXƒŒƒxƒ‹C

‰đŕ

p‘O’_“šƒhƒŒƒi[ƒW‚Ě•ű–@‚É‚ÍŽĺ‚Ć‚ľ‚ÄPTBDAENBDAEBS ‚Ş‚ ‚é‚ŞA‚ť‚ę‚ç‚đ”äŠr‚ľ‚˝‘OŒü‚ŤŽŽŒą‚Í‚Č‚˘BŒă‚ëŒü‚ŤŽŽŒą‚Ĺ‚Í‚˘‚¸‚ę‚Ě•ű–@‚đ—p‚˘‚Ä‚ŕŒ¸‰ŠŒř‰Ę‚âŘœpŒă‚̍‡•šÇ”­ś—Ś‚ɍˇ‚Í‚Č‚˘‚Ć•ń‚ł‚ę‚Ä‚˘‚é1jB

‚ľ‚Š‚ľAPTBD ‚͐úŽhŽž‚Ě–ĺ–Ź‘š‚đ‚Ť‚˝‚ˇ‰Â”\Ť1jAᑍEÄ”­‚â• –Œ”dŽí‚ĚŒ´ˆö‚Ć‚Č‚é‰Â”\Ť‚Ş—L‚č2jA‘ćˆę‘I‘đ‚Ć‚ˇ‚ׂŤ‚Ĺ‚Č‚˘BEBS ‚Í’_`“ŕᑏp‚Ĺ‚ ‚čAś—“IƒhƒŒƒi[ƒW‚Ĺ‚ ‚é‚ŕ‚Ě‚ĚƒXƒeƒ“ƒg•ÂÇ—Ś‚ލ‚‚­1jA’_ŠÇ‰Š‚Ě”­ÇƒŠƒXƒN‚ލ‚‚˘B‚ť‚Ě‚˝‚߁AL”ͩ̐؏œ‚đ—v‚ˇ‚éă•”EŠĚ–ĺ•”’_ŠÇ•ÂÇ‚Ěę‡‚É‚ÍENBD ‚É‚ć‚錸‰Šˆ’u‚Ş‘ć1‘I‘đ‚Ć‚ľ‚Đ„§‚ł‚ę‚é1, 3, 4jB

ˆę•űA’†‰ş•”’_ŠÇ•ÂÇ‚ɑ΂ˇ‚éƒhƒŒƒi[ƒW–@‚Ć‚ľ‚ÄŒťó‚Ĺ‚Í‘˝‚­‚ĚÇ—á‚ÉEBS ‚Ş‘I‘đ‚ł‚ę‚Ä‚˘‚é‚ŞA‚ą‚ę‚Ü‚ĹENBD ‚Ć‚ĚŠÔ‚Ĺ—L—pŤ‚đ”äŠr‚ľ‚˝•ń‚Í‚Č‚˘B

L”ͩ̐؏œ•K—v‚Ć‚ˇ‚éÇ—á‚ɑ΂ˇ‚éƒhƒŒƒi[ƒW‚ÍŽcŠĚ‘¤‚Ě‚Ý‚Ĺ—Ç‚˘‚Ć‚ł‚ę‚é‚Ş1, 3, 4jAŠĚ–ĺ•”‚Ĺ•Ą”‚Ě’_ŠÇŽ}‚ޕǂľ‚Ä‚˘‚éę‡‚âA”ńƒhƒŒƒi[ƒW—Ěˆć‚Ě’_ŠÇ‰Š”­ÇŽž‚É‚Í2 –{‚ ‚邢‚Í3 –{‚ĚENBD ‚đ•K—v‚Ć‚ľ‚˝‚čAPTBD ‚đ‘g‚ݍ‡‚í‚š‚˝ƒhƒŒƒi[ƒW‚Ş•K—v‚Ć‚Č‚é1, 3, 4jB

‹ß”NA–{–M‚Ĺ‚ÍMDCT ‚Ş‹}‘Ź‚É•‹y‚ľA’_ŠÇ•a•Ď‚Ě‹ÇÝf’f‚âi“W“xf’f‚É—L—p‚ČŒŸ¸‚Ć‚ľ‚Ä•p—p‚ł‚ę‚Ä‚˘‚éiCQ7 ‚đŽQĆjBƒhƒŒƒi[ƒWƒ`ƒ…[ƒu—Ż’uŒă‚É‚Í’_ŠÇ‚ɉŠÇŤ•Ď‰ť‚މÁ‚í‚čAŠŕ‚É‚ć‚é•Ç”ěŒú‚Ć‚ĚŠÓ•Ę‚Ş˘“ď‚Ć‚Č‚é‚˝‚߁A’_“šƒhƒŒƒi[ƒW‚ÍMDCT ‚ĚŽB‰eŒă‚ɍs‚¤‚ׂŤ‚Ĺ‚ ‚č5jA‚Ü‚˝AEUS AIDUS ‚âPOCS ‚Č‚Ç‚Ě’_“š¸¸‚ŕƒhƒŒƒi[ƒW‚Ě‘O‚ɍs‚¤‚ą‚Ć‚Ş–]‚Ü‚ľ‚˘6-8jB

ŽQl•śŒŁ

1j Kawakami H, Kuwatani M, Onodera M, Haba S, Eto K, Ehira N, Yamato H, Kudo T, Tanaka E, Hirano S, Kondo S, Asaka M. Endoscopic nasobiliary drainage is the most suitable preoperative biliary drainage method in the management of patients with hilar cholangiocarcinoma. J Gastroenterol. 2011; 46: 242-248.

2j Takahashi Y, Nagino M, Nishio H, Ebata T, Igami T, Nimura Y. Percutaneous transhepatic biliary drainage catheter tract recurrence in cholangiocarcinoma. Br J Surg. 2010; 97: 1860-1866.

3j Arakura N, Takayama M, Ozaki Y, Maruyama M, Chou Y, Kodama R, Ochi Y, Hamano H, Nakata T, Kajikawa S, Tanaka E, Kawa S. Efficacy of preoperative endoscopic nasobiliary drainage for hilar cholangiocarcinoma. J Hepatobiliary Pancreat Surg. 2009; 16: 473-477.

4j Kawashima H, Itoh A, Ohno E, Itoh Y, Ebata T, Nagino M, Goto H, Hirooka Y. Preoperative Endoscopic Nasobiliary Drainage in 164 Consecutive Patients With Suspected Perihilar Cholangiocarcinoma: A Retrospective Study of Efficacy and Risk Factors Related to Complications. Ann Surg. 2012; 257: 121-7.

5j Unno M, Okumoto T, Katayose Y, Rikiyama T, Sato A, Motoi F, Oikawa M, Egawa S, Ishibashi T. Preoperative assessment of hilar cholangiocarcinoma by multidetector row computed tomography. J Hepatobiliary Pancreat Surg. 2007; 14: 434-440.

6j Ito K, Fujita N, Noda Y, Kobayashi G, Horaguchi J, Takasawa O, Obana T. Preoperative evaluation of ampullary neoplasm with EUS and transpapillary intraductal US: a prospective and histopathologically controlled study. Gastrointest Endosc. 2007; 66: 740-747.

7j Tamada K, Nagai H, Yasuda Y, Tomiyama T, Ohashi A, Wada S, Kanai N, Satoh Y, Ido K, Sugano K. Transpapillary intraductal US prior to biliary drainage in theassessment of longitudinal spread of extrahepatic bile duct carcinoma. Gastrointest Endosc. 2001; 53: 300-307.

8j Kawakami H, Kuwatani M, Etoh K, Haba S, Yamato H, Shinada K, Nakanishi Y, Tanaka E, Hirano S, Kondo S, Kubota K, Asaka M. Endoscopic retrograde cholangiography versus peroral cholangioscopy to evaluate intraepithelial tumor spread in biliary cancer. Endoscopy. 2009; 41: 959-964.


ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ16
ŠĚ–ĺ•”ˆŤŤ•ÂÇ‚ɑ΂ˇ‚ép‘O’_“šƒhƒŒƒi[ƒW‚́A•Đ‘¤ŠĚ—t‚Š—ź‘¤ŠĚ—tƒhƒŒƒi[ƒW‚ŠH

‚Ü‚¸‚Í‚ś‚ß‚ÉŽc‘ś—\’葤‚Ě•Đ‘¤ŠĚ—tƒhƒŒƒi[ƒW‚đs‚¤B

„§“x2@ƒGƒrƒfƒ“ƒXƒŒƒxƒ‹C

‰đŕ

pŽŽ‚Ě—§ˆÄŒăA(•Đ‘¤jŽc‘ś—t‚Ě‚Ý‚đƒhƒŒƒi[ƒW‚ˇ‚é‚ŠA‚ ‚邢‚Í—ź—t‚đƒhƒŒƒi[ƒW‚ˇ‚é‚Š‚Ĺ‚ ‚é‚ŞAŽc‘ś—t‚Ě‚Ý‚ĚƒhƒŒƒi[ƒW‚É‚Ć‚Ç‚ß‚˝•ű‚ށA—ź—tƒhƒŒƒi[ƒW‚ɔ䂾ŽcŠĚ‚Ě”ě‘ĺ—Ś‚âƒrƒŠƒ‹ƒrƒ“ŽYś”\‚Š‚ç‚Ý‚˝ŽcŠĚ‹@”\‚ޗǍD‚Č‚ą‚Ć‚ŞAŽŔŒą“I‚É‚ŕ—Տ°“I‚É‚ŕŘ–ž‚ł‚ę‚Ä‚˘‚é1, 2jBL”ͩ̐؏œ‚đ‚ć‚čˆŔ‘S‚ɍs‚¤‚˝‚߂ɂ́A—ź—t‚Ĺ‚Í‚Č‚­Žc‘ś—t‚Ě‚Ý‚đƒhƒŒƒi[ƒW‚ˇ‚é‚ą‚Ć‚Ş„§‚ł‚ę‚éB

‚ľ‚˝‚Ş‚Á‚āA‚Ü‚¸‚Í‚ś‚ß‚ÉŽc‘ś—\’葤‚Ě•Đ‘¤ŠĚ—tƒhƒŒƒi[ƒW‚đs‚˘A•Đ—tƒhƒŒƒi[ƒW‚݂̂ł́A1j’_ŠÇ‰Š‚ĚƒRƒ“ƒgƒ[ƒ‹‚Ş‚Ĺ‚Ť‚Č‚˘A2j•Đ—t‚Ě‚Ý‚Ĺ‚ÍŒ¸‰Š•s—Ç‚Č‚Ç‚Ěę‡‚ɂ́A‘Α¤—t‚ĚƒhƒŒƒi[ƒW‚đl—ś‚ˇ‚ׂŤ‚Ĺ‚ ‚é3, 4jB

ŽQl•śŒŁ

1j Noie T. Sugawara Y. Imamura H. Takayama T. Makuuchi M. Selective versus total drainage for biliary obstruction in the hepatic hilus: an experimental study. Surgery 2001; 130: 74-81.

2j Ishizawa T. Hasegawa K. Sano K. Imamura H. Kokudo N. Makuuchi M. Selective versus total biliary drainage for obstructive jaundice caused by a hepatobiliary malignancy. Am J Surg. 2007; 193: 149-54.

3j Arakura N. Takayama M. Ozaki Y. Maruyama M. Chou Y. Kodama R. et al. Efficacy of preoperative endoscopic nasobiliary drainage for hilar cholangiocarcinoma. J Hepatobiliary Pancreat Surg 2009; 16: 473-477.

4j Kawakami H .Kuwatani M. Onodera M. Haba S. Eto K. Ehira N. et al. Endoscopic nasobiliary drainage is the most suitable preoperative biliary drainage method in the management of patients with hilar cholangiocarcinoma. J Gastroenterol 2011; 46: 242-248.


ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ17
’_“šƒhƒŒƒi[ƒWŒă‚Ě”­”M‚̑Ήž‚́H

’_“šƒhƒŒƒi[ƒW’†‚É”­”M‚Ş‚ ‚ę‚΁A‚Ü‚¸’_ŠÇ‰Š‚đ‹^‚¤B’_”X‰Š‚âäX‰Š‚̉”\Ť‚ŕ‚ ‚éB
’_ŠÇ‰Š‚Ɛf’f‚ł‚ę‚ę‚΍R‹Ű–ň‚đ“Š—^‚ľAƒ`ƒ…[ƒuƒgƒ‰ƒuƒ‹‚Ě—L–ł‚đŠm”F‚ˇ‚éBƒ`ƒ…[ƒuƒgƒ‰ƒuƒ‹‚Ş‚ ‚ę‚΃`ƒ…[ƒuŒđŠˇ‚đs‚¤B

„§“x1@ƒGƒrƒfƒ“ƒXƒŒƒxƒ‹B

ƒ`ƒ…[ƒuƒgƒ‰ƒuƒ‹‚Ş–ł‚˘A‚ ‚邢‚Í2`3“ú‚ʼnđ”M‚ľ‚Č‚˘ę‡‚ɂ́AƒhƒŒƒi[ƒW•s—Ç’_ŠÇ‚Ě‘śÝ‚đ‹^‚˘AƒhƒŒƒi[ƒW‚đ’ljÁ‚ˇ‚éB

„§“x2@ƒGƒrƒfƒ“ƒXƒŒƒxƒ‹C

‰đŕ

’_“šƒhƒŒƒi[ƒW’†‚É”­”M‚đ‚Ť‚˝‚ľ‚˝ę‡A‚Ü‚¸ƒ`ƒ…[ƒuƒgƒ‰ƒuƒ‹i•ÂÇA‹ü‹ČAˆí’EA–Ŕ“üj‚É‚ć‚é’_ŠÇ‰Š‚đ‹^‚¤BPTBD ‚âENBD ‚Ěę‡‚É‚Í’_`‚Ě”r‰t—ʂ␍ó‚đƒ`ƒFƒbƒN‚ľAƒ`ƒ…[ƒu‚Ě‹l‚Ü‚č‚âƒ`ƒ…[ƒuˆĘ’u‚̕ωť‚đŠm”F‚ˇ‚éB•K—v‚ɉž‚ś‚Ä• •”’PƒƒŒƒ“ƒgƒQƒ“ŒŸ¸‚ⓧŽ‹‚É‚ć‚éƒ`ƒ…[ƒuˆĘ’u‚ĚŠm”F‚â’_“š‘˘‰e‚đs‚¤BEBS ‚Ěę‡‚É‚Í• •”’PƒƒŒƒ“ƒgƒQƒ“ŒŸ¸‚Ĺƒ`ƒ…[ƒu‚Ěˆí’E‚â–Ŕ“ü‚Ş‚Č‚˘‚Š‚đŠm”F‚ˇ‚éBƒ`ƒ…[ƒu‹l‚Ü‚č‚âˆĘ’u‚̕ωť‚Ě‚Č‚˘ę‡‚ɂ́A’_”XŠÇ•ÂÇ‚É‚ć‚é’_”X‰ŠAŒo“ű“Ş“IƒhƒŒƒi[ƒW‚Ěę‡‚É‚ÍäXŠÇ•ÂÇ‚É‚ć‚éäX‰Š‚̉”\Ť‚ŕl—ś‚ˇ‚éB‚ą‚ę‚ç‚ĚŠÓ•Ę‚É‚ÍCT ‚Ş—L—p‚Ĺ‚ ‚é1-4jB

ƒ`ƒ…[ƒuƒgƒ‰ƒuƒ‹‚É‚ć‚é’_ŠÇ‰Š‚Ɛf’f‚ł‚ę‚ę‚΁AR‹ŰÜ‚Ě“Š—^‚Ć‚Ć‚ŕ‚ɁAƒ`ƒ…[ƒuŒđŠˇ‚đs‚¤Bƒ`ƒ…[ƒuƒgƒ‰ƒuƒ‹‚Ş–ł‚˘ę‡A‚ ‚邢‚̓`ƒ…[ƒuŒđŠˇŒă2`3 “ú‚ľ‚Ä‚ŕ‰đ”M‚ľ‚Č‚˘ę‡‚ɂ́i‘˝‚­‚Í•Ą”–{‚Ě’_ŠÇ•ÂÇ‚𔺂¤ŠĚ–ĺ•”’_ŠÇ•ÂÇ—á‚Ĺ‚ ‚éjAƒhƒŒƒi[ƒW•s—Ç’_ŠÇ‚Ě‘śÝ‚đ‹^‚¤B‘˘‰eCT‚đs‚Á‚ăhƒŒƒi[ƒW•s—Ç’_ŠÇ‚đ“Á’č‚ľAPTBD‚âENBD ‚đ’ljÁ‚ˇ‚é‚ŠA‚ˇ‚Ĺ‚É‘}“ü‚ł‚ę‚Ä‚˘‚éPTBD ƒ`ƒ…[ƒu‚đ”ńƒhƒŒƒi[ƒW’_ŠÇ‚É—U“ą‚ˇ‚é1, 2, 4, 5jB

’_ŠÇ‰Š‚Ě‘śÝ‚́AŽcŠĚ‚̍Đś‚đ‘jŠQ‚ˇ‚é‚ą‚Ć‚ŞŽŔŒą“I‚ÉŘ–ž‚ł‚ę‚Ä‚˘‚é6jB‚Ü‚˝ApŒă‚ĚŠ´őŤ‡•šÇ‚݂̂Ȃ炸A’_ŠÇ‰Š‚͍݉@Ž€–S‚đ‚Ť‚˝‚ˇ—LˆÓ‚ČˆöŽq‚Ć‚Č‚é‚ą‚Ć‚Š‚çAv‘Ź‚Š‚“KŘ‚ȑΉž‚Ş•K—v‚Ĺ‚ ‚é5, 7-9jB

ŽQl•śŒŁ

1j Maguchi H. Takahashi K. Katanuma A. Osanai M. Nakahara K. Matuzaki S. et al. Preoperative biliary drainage for hilar cholangiocarcinoma. J Hepatobiliary Pancreat Surg 2007; 14: 441-446.

2j Arakura N. Takayama M. Ozaki Y. Maruyama M. Chou Y. Kodama R. et al. Efficacy of preoperative endoscopic nasobiliary drainage for hilar cholangiocarcinoma. J Hepatobiliary Pancreat Surg 2009; 16: 473-477.

3j Kloek JJ. van der Gaag NA. Aziz Y. Rauws EA. van Delden OM. Lameris JS. Et al. Endoscopic and percutaneous preoperative biliary drainage in patients with suspected hilar cholangiocarcinoma. J Gastrointest Surg 2010; 14: 119-125.

4j Kawakami H. Kuwatani M. Onodera M. Haba S. Eto K. Ehira N. et al. Endoscopic nasobiliary drainage is the most suitable preoperative biliary drainage method in the management of patients with hilar cholangiocarcinoma. J Gastroenterol 2011; 46: 242-248.

5j Kanai M. Nimura Y. Kamiya J. Kondo S. Nagino M. Miyachi M. et al. Preoperative intrahepatic segmental cholangitis in patients with advanced carcinoma involving the hepatic hilus. Surgery 1996; 119: 498-504.

6j Watanabe K. Yokoyama Y .Kokuryo T. Kawai K. Kitagawa T. Seki T. et al. Segmental cholangitis impairs hepatic regeneration capacity after partial hepatectomy in rats. HPB (Oxford) 2010; 12: 664-673.

7j Jagannath P. Dhir V. Shrikhande S. Shah RC. Mullerpatan P. Mohandas KM. Effect of preoperative biliary stenting on immediate outcome after pancreaticoduodenectomy. Br J Surg 2005; 92: 356-361.

8j Sano T, Shimada K, Sakamoto Y, Yamamoto J, Yamasaki S, Kosuge T. One hundred two consecutive hepatobiliary resections for perihilar cholangiocarcinoma with zero mortality. Ann Surg 2006; 244: 240-247.

9j Sakata J. Shirai Y. Tsuchiya Y. Wakai T. Nomura T. Hatakeyama K. Preoperative cholangitis independently increases in-hospital mortality after combined major hepatic and bile duct resection for hilar cholangiocarcinoma. Langenbecks Arch Surg 2009; 394: 1065-1072.


ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ18
p‘OŠOᑃhƒŒƒi|ƒWŠłŽŇ‚É‚¨‚˘‚Ä’_`”|—{‚͍s‚¤‚ׂŤ‚ŠH

’_`ŠÄŽ‹”|—{‚ÍŽüpŠú‚É‚¨‚Ż‚éR‹Ű–ň‚Ě‘I‘đ‚É—L—p‚Ĺ‚ ‚éB

„§“x1@ƒGƒrƒfƒ“ƒXƒŒƒxƒ‹C

‰đŕ

’_`ŠÄŽ‹”|—{‚Ƃ́AŠOᑃhƒŒƒi|ƒWŠłŽŇ‚É‚¨‚˘‚ÄŠ´ő’ĽŒó‚Ě‚Č‚˘Žž“_‚Ĺ’čŠú“I‚É’_`”|—{‚đs‚¤‚ą‚Ć‚Ĺ‚ ‚éB’_`Š´ő‚̏ó‘Ô‚đ”cˆŹ‚ľ‚Ä‚¨‚­‚ą‚ƂŁAp‘OA‹}‚É’_ŠÇ‰Š‚đ”­Ç‚ľ‚˝Ű‚ȂǁA‘Ź‚â‚Š‚ÉŠ´ŽóŤ‚Ě‚ ‚éR‹Ű–ň“Š—^‚đŠJŽn‚ˇ‚é‚ą‚Ć‚Ş‰Â”\‚Ć‚Č‚éB

’_“šÄŒš‚𔺂¤L”ÍˆÍŠĚŘœp‚É‚¨‚˘‚āAŠ´őŤ‡•šÇ”­Ç‚Ě‘ĺ‚Ť‚ČŒ´ˆö‚̂ЂƂ‚ɒ_`Š´ő‚Ş‹“‚°‚ç‚ę‚éBŠĚ–ĺ•”’_ŠÇŠŕ‚ɑ΂ˇ‚éL”ÍˆÍŠĚŘœ‚đŽ{s‚ľ‚˝Ç—á‚ɂ‚˘‚ďp‘O’_`Š´ő‚Ě‚ ‚éÇ—á‚É‚¨‚˘‚ďpŒăŠ´őÇi“Á‚É‘nŠ´ő‚â• o“ੴőj‚̍‡•š‚ˇ‚é•p“x‚ލ‚‚­1jA‚ľ‚Š‚ŕ30-88“‚ĚÇ—á‚Ĺ’_`ŠÄŽ‹”|—{‚Ć“Ż—l‚Ě×‹Ű‘p‚ŞŒŸo‚ł‚ę‚˝‚Ć•ń‚ł‚ę‚Ä‚˘‚é2-4jB

‚ľ‚˝‚Ş‚Á‚āA’_`ŠÄŽ‹”|—{‚đŽ{s‚ˇ‚é‚ą‚Ć‚É‚ć‚čAŽüpŠú‚É‚¨‚Ż‚é—\–h“IR‹Ű–ň‚¨‚ć‚сApŒăŠ´ő‚ɑ΂ˇ‚鎥—Ă“IR‹Ű–ň‚đ“KŘ‚É‘I‘đ‚ˇ‚é‚ą‚Ć‚Ş‰Â”\‚É‚Č‚é4-8jB

ŽQl•śŒŁ

1j Sakata J, Shirai Y, Tsuchiya Y, Wakai T, Nomura T, Hatakeyama K. Preoperative cholangitis independently increases in-hospital mortality after combined major hepatic and bile duct resection for hilar cholangiocarcinoma. Langenbecks Arch Surg 2009; 394: 1065-72.

2j Povoski SP, Karpeh MS, Jr., Conlon KC, Blumgart LH, Brennan MF. Preoperative biliary drainage: impact on intraoperative bile cultures and infectious morbidity and mortality after pancreaticoduodenectomy. J Gastrointest Surg 1999; 3: 496-505.

3j Cortes A, Sauvanet A, Bert F, Janny S, Sockeel P, Kianmanesh R, et al. Effect of bile contamination on immediate outcomes after pancreaticoduodenectomy for tumor. J Am Coll Surg 2006; 202: 93-9.

4j Sugawara G, Ebata T, Yokoyama Y, Igami T, Takahashi Y, Takara D, Nagino M. The effect of preoperative biliary drainage on infectious complications after hepatobiliary resection with cholangiojejunostomy. Surgery 2013; 153: 200-10.

5j â–{˜a•FA‰Ş“c•qłAˆ×˛‘ě•vA‰Şł˜NDáŠQŠĚ‚đ”wŒi‚Ć‚ˇ‚éŠĚŘœ—á‚É‚¨‚Ż‚éŽüpŠú×‹Ű”|—{. “úŠOŠ´ő‰ďŽ 2006; 3: 83-86.

6j “Ąˆä‹`˜YA‰““ĄŠiA‘ŹGŽ÷AâV“ĄCŽĄA_’J‹I”VA‰i–ě–ő•FA‘ź. ’_`”|—{‚Š‚ç‚Ý‚˝ˆŤŤ’_“šŽžŠł‚̏pŒăR‹Ű–ň‚Ě“Š—^–@‚ɂ‚˘‚Ä. ’_“š 2001; 15: 375-380.

7j Hochwald SN, Burke EC, Jarnagin WR, Fong Y, Blumgart LH. Association of preoperative biliary stenting with increased postoperative infectious complications in proximal cholangiocarcinoma. Arch Surg 1999; 134: 261-6.

8j Takara D, Sugawara G, Ebata T, Yokoyama Y, Igami T, Nagino M. Preoperative biliary MRSA infection in patients undergoing hepatobiliary resection with cholangiojejunostomy: incidence, antibiotic treatment, and surgical outcome. World J Surg 2011; 35: 850-7.


ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ19
ŠOᑊłŽŇ‚É‚¨‚Ż‚é’_`•ÔŠŇ‚Í—L—p‚ŠH

’_`•ÔŠŇ‚Í—L—p‚Ĺ‚ ‚čC•ÔŠŇ‚ˇ‚é‚ą‚Ć‚đl—ś‚ľ‚Ä‚ŕ‚悢B

„§“x2@ƒGƒrƒfƒ“ƒXƒŒƒxƒ‹C

‰đŕ

ƒqƒg‚ł́C•ÂÇŤ‰Šát‚É‚ć‚é’°ŠÇ”S–Œ‚Ě“§‰ßŤ‚Ě˜´i‚ށC“ŕᑃhƒŒƒi|ƒWiEBSj‚É‚ć‚萳í‰ť‚ˇ‚é‚Ć‚ł‚ę‚é‚Ş1, 2jAŠOᑃhƒŒƒi|ƒWiPTBDj‚É‚¨‚˘‚Ä‚ŕCƒhƒŒƒi|ƒW‚ł‚ę‚˝’_`‚đˆů—p‚Č‚Ç‚É‚ć‚č’°ŠÇ“ŕ‚É•ÔŠŇ‚ˇ‚é‚ą‚Ć‚É‚ć‚čC“ŕᑃhƒŒƒi|ƒW‚Ć“Ż—l‚É’°ŠÇ”S–Œ‚Ě“§‰ßŤ‚Ş’á‰ş‚ľC’°ŠÇ‚̖Ɖu‹@”\‚މń•œ‚ˇ‚é‚ą‚Ć‚Ş•ń‚ł‚ę‚Ä‚˘‚é3jB

’_`‚Ě’°ŠĚzŠÂ‚Ş•Ű‚˝‚ęCÁ‰ťŠÇ‚̖Ɖu‹@”\‚ŞˆŰŽ‚ł‚ę‚Ä‚˘‚é‚ą‚Ć‚Şś‘Ě‚É‚Ć‚Á‚ďd—v‚Ĺ‚ ‚éD‚ľ‚˝‚Ş‚Á‚ÄŠOᑎž‚̏p‘O’_`•ÔŠŇ‚́CNP‚̍‚“x‚ČŽčpi’_“šŠŕ‚ɑ΂ˇ‚éL”ÍˆÍŠĚŘœ‚Ȃǁj‚Ş—\’č‚ł‚ę‚Ä‚˘‚éę‡‚É‚Í—L—p‚Ĺ‚ ‚é‰Â”\Ť‚ލ‚‚˘D‚ľ‚Š‚ľCp‘O’_`•ÔŠŇ‚ލ‡•šÇ”­ś—ŚC“Á‚ÉŠ´őŤ‡•šÇ‚Ě”­ś—Ś‚đ—LˆÓ‚ɒቺ‚ł‚š‚é‚Ů‚Ç‚Ě‚ŕ‚Ě‚ŠH‚Ć‚˘‚¤“_‚ɂ‚˘‚Ä‚Í—Ő°ŽŽŒą‚É‚ć‚錟“˘‚Ş•K—v‚Ĺ‚ ‚éB

ŽQl•śŒŁ

1j Parks RW, Clements WD, Smye MG, Pope C, Rowlands BJ, Diamond T. Intestinal barrier dysfunction in clinical and experimental obstructive jaundice and its reversal by internal biliary drainage. Br J Surg 1996; 83: 1345-9.

2j Welsh FK, Ramsden CW, MacLennan K, Sheridan MB, Barclay GR, Guillou PJ, et al. Increased intestinal permeability and altered mucosal immunity in cholestatic jaundice. Ann Surg 1998; 227: 205-12.

3j Kamiya S, Nagino M, Kanazawa H, Komatsu S, Mayumi T, Takagi K, et al. The value of bile replacement during external biliary drainage: an analysis of intestinal permeability, integrity, and microflora. Ann Surg 2004; 239: 510-7.


ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ20
Řœ•s”\—á‚É’_“šƒhƒŒƒi[ƒW‚͐„§‚ł‚ę‚é‚ŠH

’_“šƒhƒŒƒi[ƒW‚͉”\‚ČŒŔ‚čs‚¤‚ׂŤ‚Ĺ‚ ‚éB

„§“x2@ƒGƒrƒfƒ“ƒXƒŒƒxƒ‹C

‰đŕ

•ÂÇŤ‰Šát‚Ě•ú’u‚Í‘~áyŠ´AHŽv•sUAŒ‘‘ÓŠ´‚Č‚Ç‚ĚÇó‚ŞoŒť‚ľ‚ÄQOL ‚đ’˜‚ľ‚­‘š‚Č‚¤‚݂̂Ȃ炸AŠĚ•s‘SAt•s‘S‚ւƐi“W‚ˇ‚é‚ą‚Ć‚Ş’m‚ç‚ę‚Ä‚˘‚éB‚Ü‚˝A’_“šƒhƒŒƒi[ƒW‚É‚ć‚čg‘ĚÇó‚ž‚Ż‚Ĺ‚Č‚­A•s–°‚â‹C•Ş•s‰ő“™¸_EŠ´î–ʁAŽĐ‰ď–Ę‚Ĺ‚ŕQOL ‚̉ü‘P‚đ”F‚ß‚˝‚Ć‚˘‚¤•ń‚ÍŽUŒŠ‚ł‚ęAŠÉ˜aŽĄ—Ă‚Ć‚ľ‚Ä‚ĚŒř‰Ę‚ŞŠú‘Ň‚Ĺ‚Ť‚é1-3jBˆČă‚ć‚čA“úí—Տ°ă‚Í’_“šƒhƒŒƒi[ƒW‚đŽ{s‚ˇ‚é‚Ě‚Ş“–‘R‚ƍl‚Ś‚ç‚ę‚Ä‚˘‚éB

ˆę•űA’_“šƒhƒŒƒi[ƒW‚đŽ{s‚ľ‚Ä‚ŕŒ¸‰Š‚âQOL ‰ü‘P‚ŞŒŠ‚ç‚ꂸ‚ɑމ@•s”\‚Ĺ‚ ‚Á‚˝‚čAƒhƒŒƒi[ƒWŽč‹Z‚âƒhƒŒƒi[ƒWƒ`ƒ…[ƒu‚Ě‚˝‚ß‚ÉQOL ‚đ‘š‚Ë‚˝‚股‚éÇ—á‚đŽž‚ÉŒoŒą‚ˇ‚éBŒ´ˆöŽžŠłA•aŠúAperformance statusA”F’mÇ‚Ě—L–ł‚Č‚Ç‚đ\•Şl—ś‚ľ‚Ä’_“šƒhƒŒƒi[ƒW‚Ě“K‰ž‚đŒˆ’č‚ˇ‚é‚ą‚Ć‚Ş•K—v‚Ĺ‚ ‚éB‚Ü‚˝AđĄ‚Í”ńŘœ—áAÄ”­—á‚ɑ΂ľ‚ĐϋɓI‚ɉťŠw—Ă–@‚Ş‚¨‚ą‚Č‚í‚ę‚é‚悤‚É‚Č‚Á‚˝‚˝‚߁A’_“š•ÂÇ‚đ—L‚ˇ‚éÇ—á‚Ĺ‚ÍŠĚ‹@”\‰ü‘P‚Ě‚˝‚ß‚É’_“šƒhƒŒƒi[ƒW‚đs‚¤‚ą‚Ć‚Ş•K—v‚Ĺ‚ ‚éB

ŽQl•śŒŁ

1j Ballinger AB, McHugh M, Catnach SM, Alstead EM, Clark ML. Symptom relief and quality of life after stenting for malignant bile duct obstruction. Gut. 35: 467-70.1994.

2j Luman W, Cull A, Palmer KR. Quality of life in patients stented for malignant biliary obstructions. Eur J Gastroenterol Hepatol. 9: 481-4, 1997.

3j Abraham NS, Barkun JS, Barkun AN. Palliation of malignant biliary obstruction: a prospective trial examining impact on quality of life. Gastrointest Endosc 56: 835-41, 2002.


ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ21
Řœ•s”\—á‚É’_“šƒXƒeƒ“ƒg‚Ć‚ľ‚Ă͉˝‚Ş“KŘ‚ŠH

Řœ•s”\’_“šŠŕ’†‰ş•”’_ŠÇ•ÂÇ‚ɑ΂ľ‚ẮAPSiplastic stentj‚ć‚č‚ŕŠJ‘śŠúŠÔ‚Ě’ˇ‚˘SEMSiself-expandable metallic stentj‚ސ„§‚ł‚ę‚éB
ŠĚ–ĺ•”’_ŠÇ•ÂÇ‚ɑ΂ľ‚Ä‚ŕŠJ‘śŠúŠÔ‚Ě’ˇ‚˘uncovered SEMS ‚ސ„§‚ł‚ę‚é‚ŞA„§‚ˇ‚ׂŤ—Ż’uŒ`‘Ô‚ÍŠm—§‚ł‚ę‚Ä‚˘‚Č‚˘B
‚ľ‚Š‚ľA‚Ç‚ż‚ç‚Ěę‡‚ŕŽ{Ý‚˛‚Ć‚Ě‹Zp‚âf—Ñ̐§‚đl—ś‚ľAPS ‚đ‘I‘đ‚ľ‚Ä‚ŕ‚悢B

„§“x2@ƒGƒrƒfƒ“ƒXƒŒƒxƒ‹C

‰đŕ

ŠĚ–ĺ•”‚Ć’†‰ş•”‚Ě’_ŠÇ•ÂÇ‚Ĺ‚Í•a‘Ô‚ŞˆŮ‚Č‚čA‘Ώˆ‚ĚŽd•ű‚ŕˆŮ‚Č‚é‚Ě‚Ĺ—źŽŇ‚đ•Ş‚Ż‚Ä‹LÚ‚ˇ‚éBƒXƒeƒ“ƒg‚ĚŽí—Ţ‚Ć‚ľ‚Ä‚ÍPSiplastic stentjASEMSiself-expandable metallic stentj‚Ş‚ ‚čASEMS ‚Í‚ł‚ç‚Écover ‚Ě—L–ł‚É‚ć‚čuncovered SEMS ‚Ćcovered SEMS ‚É•Ş‚Ż‚ç‚ę‚éB

’†‰ş•”’_ŠÇ•ÂÇ‚Ĺ‚Í•Ą”‚Ě—Ő°ŽŽŒą‚Š‚çPS ‚ć‚čuncovered SEMS ‚ĚŠJ‘śŠúŠÔ‚Ş’ˇ‚­AƒXƒeƒ“ƒg•ÂÇˆČŠO‚̍‡•šÇ‚ÉŠÖ‚ľ‚Ä‚ŕuncovered SEMS ‚Ě•ű‚ޏ­‚Č‚˘‚ą‚Ć‚Ş•ń‚ł‚ę‚Ä‚¨‚č1-3jAƒRƒXƒg‚Ě–Ę‚Š‚ç‚ŕSEMS ‚ސ„§‚ł‚ę‚éBˆę•űA’_“šŠŕ‚É‚¨‚Ż‚écovered SEMS ‚Ćuncovered SEMS ‚Ě”äŠrŽŽŒą‚ޏ­‚Č‚­A”ď—p‘ÎŒř‰Ę‚â‹ô”­Ç‚ÉŠÖ‚ˇ‚é\•Ş‚ČƒGƒrƒfƒ“ƒX‚Ş‚Č‚˘‚˝‚߁ASEMS ‚đ„§‚ˇ‚é‚É‚Ć‚Ç‚ß‚éB

ŠĚ–ĺ•”’_ŠÇ•ÂÇ‚ÉŠÖ‚ľ‚ẮAcovered SEMS ‚Í’_ŠÇŽ}‚đÇ‚˘‚Ĺ‚ľ‚Ü‚¤‚˝‚߁AŽg—p‚Ş•s‰Â”\‚Ĺ‚ ‚éBPS ‚ć‚čuncovered SEMS ‚Ě•ű‚ށA—LˆÓ‚ÉŠJ‘śŠúŠÔ‚Ş’ˇ‚˘‚ą‚Ć‚Ş•Ą”•ń‚ł‚ę‚Ä‚˘‚é4, 5jB‚ľ‚Š‚ľAuncovered SEMS ‚Ě—Ż’u‚Í‹Zp“I‚É“ď‚­Aę–ĺŽ{ÝˆČŠO‚Ĺ‚ÍPS ‚đ‘I‘đ‚ˇ‚éŒXŒü‚É‚ ‚éB

ŠĚ–ĺ•”’_ŠÇ•ÂÇ‚Ĺ‚Í’_ŠÇŽ}‚Ş•Ş’f‚ł‚ę‚Ä‚˘‚é‚ŞAƒhƒŒƒi[ƒW—Ěˆć‚â—Ż’uŒ`‘Ô‚ÉŠÖ‚ľ‚Ä‚Í–žŠm‚ČƒGƒrƒfƒ“ƒX‚Í–ł‚˘B

‘˝‚­‚ĚŒŸ“˘‚ĹSEMS ‚̐ŹŃ‚ޗǍD‚Ĺ‚ ‚é‚ŞA—Ż’u‚â•ÂÇŽž‚Ě‘Îˆ“™‚É‚Í‹Zp“I‚ȏn—ű‚đ—v‚ˇ‚é‚̂ŁApŽŇ‚âŽ{Ý‚Ěó‹ľ‚É‰ž‚ś‚ÄPS ‚đŽg—p‚ˇ‚é‚Ě‚Í\‚í‚Č‚˘‚ĆŽv‚í‚ę‚éB‚Ü‚˝ASEMS ‚͈ę“x—Ż’u‚ˇ‚é‚Ć”˛‹Ž‚Í“ď‚ľ‚­AŽčp‚ŕ˘“ď‚Ć‚Č‚é‚˝‚߁Ap‘O‚ɐ؏œ‚̉”ۂđ\•Ş‚ÉŒŸ“˘‚ľ‚Ä‚Š‚ç“K‰ž‚đŒˆ‚ß‚é‘Ô“x‚ޏd—v‚Ĺ‚ ‚éB

ŽQl•śŒŁ

1j Smith AG, Dowset JF, Rassell RCG, Hatfield ARW, Cotton PB. Randomized trial of endoscopic stenting versus surgical bypass in malignant low bileduct obstruction. Lancet 1994; 344: 1655-60.

2j Davids PH.P., Groen AK., Rauws EA.J., et al. Randomized trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet 1992; 340: 1488-1492.

3j Lammer J, Hausegger KA, Fluckiger F, et al. Common bile duct obstruction due to malignancy: Treatment with plastic versus metal stents. Radiology 1996; 201: 167-72.

4j Wagner HJ, Knyrim K, Vakil N, Klose KJ. Plastic versus metallic stents in the palliative treatment of malignant hilar biliary obstruction. A prospective and randomized trial. Endoscopy 1993; 25: 213-218.

5j Mukai T, Yasuda I, Nakashima M, Doi S, Iwashita T, Iwata K, Kato T, Tomita E, Moriwaki H.@Metallic stents are more efficacious than plastic stents in unresectable malignant hilar biliary strictures: a randomized controlled trial. J Hepatobiliary Pancreat Sci. 2013; 20: 214-22.


ŠO‰ČŽĄ—Ă

ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ22
Řœ•s”\‚Č’_“šŠŕ‚͂ǂ̂悤‚Č‚ŕ‚Ě‚ŠH

ŠĚ“]ˆÚA”x“]ˆÚAœ“]ˆÚA• –Œ”dŽíA‰“ŠuƒŠƒ“ƒpß“]ˆÚi–ž‚ç‚Š‚Č–T‘ĺ“Ž–ŹŽüˆÍƒŠƒ“ƒpßA• oŠOƒŠƒ“ƒpß‚Č‚Ç‚Ě“]ˆÚj‚𔺂¤’_“šŠŕ‚͐؏œ‚đs‚í‚Č‚˘‚ą‚Ć‚đ„§‚ˇ‚éB‹ÇŠi“W‚É‚ć‚éŘœ‰Â”\‚Š”Ű‚Š‚ɂ‚˘‚Ä‚Í–ž‚ç‚Š‚ČƒRƒ“ƒZƒ“ƒTƒX‚Í‚Č‚˘B

„§“x1@ƒGƒrƒfƒ“ƒXƒŒƒxƒ‹C

‰đŕ

’_“šŠŕ‚ɑ΂ľ‚ÄŠO‰ČŘœ‚މ”\‚Š”Ű‚Š‚𔝒f‚ˇ‚é‚ɂ́A‘ź‚ĚˆŤŤŽžŠł‚Ć“Ż—l‚ÉŠłŽŇ‚Ě‘Sgó‘ԁAŽîᇂ̋ǏŠi“WA“]ˆÚiƒŠƒ“ƒpßAŠĚA• –ŒA”xA‘źj‚ĚŠeˆöŽq‚Ě•]‰ż‚Ş•K—v‚É‚Č‚é1jBˆę”ʂɁA‘Sgó‘Ô‚ŞŠO‰ČŽčp‚É‘Ďp‰Â”\‚Š”Ű‚Š‚Ě”ť’f‚Í‘I‘đ‚ˇ‚épŽŽ‚ĚŽčpNP‚É‚ć‚čˆŮ‚Č‚é‚ŞA’_“šŠŕ‚Ĺ‚ÍŠĚŘœ‚âäX“ޏ\“ńŽw’°Řœp‚đŠÜ‚Ţmajor surgery‚Ş•K—v‚Ć‚ł‚ę‚é‚ą‚Ć‚Ş‘˝‚­AŠĚASA”xAt‹@”\‚âperformance status ‚đŠÜ‚ß‚˝Td‚ȏp‘O•]‰ż‚Ş‹‚ß‚ç‚ę‚é2jB

’_“šŠŕ‚̉“Šu“]ˆÚA‚ˇ‚Č‚í‚żŠĚ“]ˆÚA”x“]ˆÚAœ“]ˆÚA• –Œ”dŽíA‰“ŠuƒŠƒ“ƒpß“]ˆÚi–ž‚ç‚Š‚Č–T‘ĺ“Ž–ŹŽüˆÍƒŠƒ“ƒpßA• oŠOƒŠƒ“ƒpß‚Č‚Ç‚Ě“]ˆÚj‚đŘœ•s”\‚Ć‚ˇ‚é‚ą‚Ƃ́A‹­‚˘ƒGƒrƒfƒ“ƒX‚Í‘śÝ‚ľ‚Č‚˘‚ރRƒ“ƒZƒ“ƒTƒX‚Ş“ž‚ç‚ę‚Ä‚˘‚é‚ŕ‚Ě‚Ćl‚Ś‚é2-4jB

ˆę•űA‹ÇŠi“W‚Ĺ‚ĚŘœ‰Â”\A•s”\‚ÉŠÖ‚ľ‚Ă͈ę’č‚ĚƒRƒ“ƒZƒ“ƒTƒX‚Í“ž‚ç‚ę‚Ä‚˘‚Č‚˘5jBAJCC/UICC ‘ć7 ”Ĺ‚Ěperihilar cholangiocarcinoma ‚ł́AŘœ•s”\‚Ş‘z’č‚ł‚ę‚éT4 ‚́A—ź‘¤‚Ě–ĺ–ŹZA‘ŠĚ“Ž–ŹZA—ź‘¤‚Ě2 ŽŸ•ŞŠň‚ւ̐ZA‘Α¤–ĺ–Ź‚Ü‚˝‚ÍŠĚ“Ž–Ź‚ւ̐ZA‚Ć‚ľ‚Ä’č‹`‚ł‚ę‚Ä‚˘‚é6jB‚ľ‚Š‚ľA“Ž–Ź‡•šŘœÄŒšp‚⍶‰EŽO‹ćˆćŘœp‚Č‚Ç‚đŽ{s‚ˇ‚é‚ą‚Ć‚É‚ć‚čA‚ą‚̂悤‚ČÇ—á‚ŕŘœ‰Â”\‚Ć‚ˇ‚éŽ{Ý‚ŕ‘˝‚­7-10jAŘœ—Ś‚â—\Œă‚Ć‘ŠŠÖ‚ˇ‚éA‚ć‚č“KŘ‚ČƒXƒe[ƒWƒ“ƒO‚Ş–]‚Ü‚ę‚Ä‚˘‚é5jB

’_”XŠŕ‚É‚¨‚˘‚Ä‚ŕ‹ÇŠi“W‚ÉŠÖ‚ľ‚ăRƒ“ƒZƒ“ƒTƒX‚Í‚Č‚˘B‰Šát”­Ç‚⃊ƒ“ƒpß“]ˆÚ‚Í—\Œă•s—LjöŽq‚Ĺ‚ ‚é‚ŞAŘœ‚É‚ć‚č—\Œă‰ü‘P‚ŞŠú‘Ň‚ł‚ę‚é11, 12jB

ŽQl•śŒŁ

1j Aloia TA, Charnsangavej C, Faria S, Ribero D, Abdalla EK, Vauthey JN, Curley SA. High-resolution computed tomography accurately predicts resectability in hilar cholangiocarcinoma. Am J Surg; 193: 702-6,2007.

2j Jarnagin WR, Fong Y, DeMatteo RP, Gonen M, Burke EC, Bodniewicz BJ, Youssef BM, Klimstra D, Blumgart LH. Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg; 234: 507-17; discussion 517-9,2001.

3j Duffy A, Capanu M, Abou-Alfa GK, Huitzil D, Jarnagin W, Fong Y, D'Angelica M, Dematteo RP, Blumgart LH, O'Reilly EM. Gallbladder cancer (GBC): 10-year experience at Memorial Sloan-Kettering Cancer Centre (MSKCC). J Surg Oncol; 98: 485-9,2008.

4j Kondo S, Nimura Y, Hayakawa N, Kamiya J, Nagino M, Uesaka K. Regional and para-aortic lymphadenectomy in radical surgery for advanced gallbladder carcinoma. Br J Surg; 87: 418-22,2000.

5j Patel T. Cholangiocarcinoma--controversies and challenges. Nat Rev Gastroenterol Hepatol; 8: 189-200,2011.

6j Blechacz B, Gores GJ. Cholangiocarcinoma: advances in pathogenesis, diagnosis, and treatment. Hepatology; 48: 308-21,2008.

7j Neuhaus P, Jonas S, Bechstein WO, Lohmann R, Radke C, Kling N, Wex C, Lobeck H, Hintze R. Extended resections for hilar cholangiocarcinoma. Ann Surg; 230: 808-18; discussion 819,1999.

8j Shimizu H, Kimura F, Yoshidome H, Ohtsuka M, Kato A, Yoshitomi H, Furukawa K, Miyazaki M. Aggressive surgical resection for hilar cholangiocarcinoma of the left-side predominance: radicality and safety of left-sided hepatectomy. Ann Surg; 251: 281-6,2010.

9j Nagino M, Nimura Y, Nishio H, Ebata T, Igami T, Matsushita M, Nishikimi N, Kamei Y. Hepatectomy with simultaneous resection of the portal vein and hepatic artery for advanced perihilar cholangiocarcinoma: an audit of 50 consecutive cases. Ann Surg; 252: 115-23,2010.

10j Miyazaki M, Kato A, Ito H, Kimura F, Shimizu H, Ohtsuka M, Yoshidome H, Yoshitomi H, Furukawa K, Nozawa S. Combined vascular resection in operative resection for hilar cholangiocarcinoma: does it work or not? Surgery; 141: 581-8,2007.

11j Nishio H, Nagino M, Ebata T, Yokoyama Y, Igami T, Nimura Y. Aggressive surgery for stage IV gallbladder carcinoma; what are the contraindications? J Hepatobiliary Pancreat Surg; 14: 351-7,2007.

12j Regimbeau JM, Fuks D, Bachellier P, Le Treut YP, Pruvot FR, Navarro F, Chiche L, Farges O. Prognostic value of jaundice in patients with gallbladder cancer by the AFC-GBC-2009 study group. Eur J Surg Oncol; 37: 505-12,2011.


ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ23
ŠĚŘœ‚𔺂¤’_“šŠŕÇ—á‚É‚¨‚˘‚ďp‘O–ĺ–ŹÇđp‚͂ǂ̂悤‚ČÇ—á‚ɍs‚¤‚ׂŤ‚ŠH

‰E—tŘœˆČă‚ ‚邢‚Í50`60“ˆČă‚̩̐؏œ‚đ—\’č‚ľ‚Ä‚˘‚é’_“šŠŕÇ—á‚ɏp‘O–ĺ–ŹÇđp‚đŽ{s‚ˇ‚é‚ą‚Ć‚đ’ńˆÄ‚ˇ‚éB

„§“x2@ƒGƒrƒfƒ“ƒXƒŒƒxƒ‹C

‰đŕ

p‘O–ĺ–ŹÇđp; PVEipreoperative portal embolizationj‚͏pŒă‚ĚŠĚ•s‘S”­ś‚đ—\–h‚ˇ‚é–Ú“I‚Ő؏œ—\’čŠĚ‚Ě–ĺ–Ź‚đ‚ ‚ç‚Š‚ś‚ßÇđ‚ˇ‚é‚ŕ‚̂ŁA—\’čŽcŠĚ‚Ě‘SŠĚ—eĎ‚ɑ΂ˇ‚é”ä—Ś‚Í8.6“`10.8“‘‘傡‚é‚Ć•ń‚ł‚ę‚Ä‚˘‚éB

PVE‚Ě—Ő°Œř‰Ę‚ÉŠÖ‚ľ‚āA‘˝”‚Ěretrospective cohort study ‚Ş•ń‚ł‚ę‚Ä‚¨‚čA‰E—tŘœˆČă‚̩̐؏œ‚É‚¨‚Ż‚éPVE ‚ޏpŒăŠĚ•s‘S‚đ‚Í‚ś‚ß‚Ć‚ˇ‚鍇•šÇ‚đŒ¸­‚ł‚š‚é‚ž‚Ż‚Ĺ‚Č‚­AŽcŠĚ—e—Ę; FLR (Future liver remnantj‚ޏŹ‚ł‚­‰fŽžŘœ•s”\‚Ĺ‚ ‚é‚ƍl‚Ś‚ç‚ę‚˝Ç—á‚đŘœ‰Â”\‚É‚Ĺ‚Ť‚éŒř‰Ę‚Ş‚ ‚é‚Ć‚ł‚ę‚Ä‚˘‚é1, 2jB

‚ľ‚Š‚ľAPVE ‚đ‚ǂ̂悤‚ČÇ—á‚ɍs‚Č‚¤‚ׂŤ‚ŠA‚ˇ‚Č‚í‚żPVE ‚Ě“K‰ž‚́wpŒăŠĚ•s‘S‚ފ뜜‚ł‚ę‚éÇ—áx‚Ć‚˘‚¤‚ą‚ƂŁA‚ť‚ĚŠî€‚ÍŽ{ÝŠÔ‚ĹˆŮ‚Č‚č–žŠm‚Č‚ŕ‚Ě‚Í‚˘‚Ü‚žŠm—§‚ł‚ę‚Ä‚˘‚Č‚˘B

PVE ‚̍‡•šÇ‚Ć‚ľ‚ẮAoŒŒA–ĺ–ŹŒŒđAƒRƒCƒ‹‚ĚmigrationA’_`ᑁiŒo”ç“IúŽh‚Ěę‡jA’_“šoŒŒA’°•ÂÇi‰ńŒ‹’°Ă–ŹƒAƒvƒ[ƒ`‚Ěę‡j‚Ş‚ ‚°‚ç‚ę‚é3jB‚ť‚Ě•p“x‚͏­‚Č‚­A‚Ü‚˝APVE Œă‚ɩ̐؏œ‚đs‚Č‚Á‚˝’_ŠÇŠŕÇ—á‚ĆPVE ‚đŽ{s‚š‚¸‚É50“–˘–ž‚̩̐؏œ‚đs‚Č‚Á‚˝Ç—á‚̐ś‘ś—Ś‚ɍˇ‚Ş‚Č‚˘‚Ć‚˘‚¤•ń‚ŕ—L‚č4jAPVE ŽŠ‘Ě‚Şś–˝‚đ‹ş‚Š‚ˇd‘ĺ‚ȍ‡•šÇ‚đˆř‚Ť‹N‚ą‚ˇ•p“x‚͒ႢB

ˆČă‚̂悤‚ɁA’_“šŠŕŠĚŘœ‚É‚¨‚˘‚ÄPVE ‚Ě—L–ł‚ĹRCT ‚đs‚Č‚Á‚˝•ń‚Í‚Č‚­A‘唟‚ÍŠĎŽ@Œ¤‹†‚Ĺ‚ ‚čƒGƒrƒfƒ“ƒXƒŒƒxƒ‹‚͒ႢB‚ľ‚Š‚ľŠĚ‰E—tŘœA‚ ‚邢‚ÍŽO‹ćˆćŘœ‚đ•p”ɂɍs‚Č‚¤‚悤‚É‚Č‚Á‚˝ŒťÝ‚Ĺ‚ŕ•Ą”‚ĚŒ¤‹†ŽŇ‚ŞPVE Œă‚Ě’_“šŠŕŠĚŘœ‚ĚÝ‰@Ž€–S—Ś‚Ş0`2“‚Ć•ń‚ľ‚Ä‚˘‚éB‚ą‚ę‚ɑ΂ľ‚āAŠĚŘœŒăÝ‰@Ž€–S—Ś‚Ş”äŠr“I‚‚˘i10`21“j•ń‚É‹¤’Ę‚ˇ‚é“_‚ÍPVE ‚Ě“K‰ž‚đ”äŠr“IŹ‚ł‚˘FLRi25`30“j‚ÉĚ—p‚ľ‚Ä‚˘‚éŽ{Ý‚Ĺ‚ ‚é5, 6jB‚ˇ‚Č‚í‚żPVE ‚͉˝‚ç‚Š‚Ě—Ő°Œř‰Ę‚đ—L‚ˇ‚é‚ŕ‚̂Ɛ„Ž@‚ł‚ę‚éBPVE ‚͊̉E—tŘœˆČă‚ ‚邢‚Í60“ˆČă‚̩̐؏œ—Ś‚ĚÇ—á‚đ“K‰ž‚Ć‚ˇ‚éŽ{Ý‚Ş‘˝‚˘‚ށAäX“ޏ\“ńŽw’°Řœ‚⌌ŠÇ‡•šŘœ‚𕚎{‚ˇ‚邢‚í‚ä‚écomplex surgery ‚Ĺ‚ÍŽ€–S—Ś‚ލ‚‚˘‚˝‚ß4jA‚ť‚̂悤‚ČŽčp‚đs‚Č‚¤‰Â”\Ť‚Ě‚ ‚éÇ—á‚ł́AŘœ—Ś50“ˆČă‚̩̐؏œ‚ɑ΂ľ‚ÄPVE ‚đŽ{s‚ľ‚Ä‚ŕŠłŽŇ‚Ě•s—˜‰v‚É‚Í‚Č‚ç‚Č‚˘‚ƍl‚Ś‚ç‚ę‚éB

ŽQl•śŒŁ

1j Farges O, Belghiti J, Kianmanesh R, Regimbeau JM, Santoro R, Vilgrain V, Denys A, Sauvanet A. Portal vein embolization before right hepatectomy: prospective clinical trial. Ann Surg. 2003 Feb; 237: 208-17.

2j Abdalla EK, Barnett CC, Doherty D, Curley SA, Vauthey JN. Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization. Arch Surg. 2002 Jun; 137: 675-80; discussion 680-1.

3j Ebata T, Yokoyama Y, Igami T, Sugawara G, Takahashi Y, Nagino M. Portal Vein Embolization before Extended Hepatectomy for Biliary Cancer: Current Technique and Review of 494 Consecutive Embolizations. Dig Surg. 2012; 29: 23-9. Epub 2012 Mar 15.

4j Nagino M, Kamiya J, Nishio H, Ebata T, Arai T, Nimura Y. Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer. Surgical outcome and long-term follow-up. Ann Surg 2006: 243; 364-372.

5j Kennedy TJ, Yopp A, Qin Y, Zhao B, Guo P, Liu F, Schwartz LH, Allen P, D'Angelica M, Fong Y, DeMatteo RP, Blumgart LH, Jarnagin WR. Role of preoperative biliary drainage of liver remnant prior to extended liver resection for hilar cholangiocarcinoma. HPB (Oxford). 2009 Aug; 11: 445-51.

6j YK Hong, Choi SB, Lee KH, Park SW, Park YN, Choi JS, Lee WJ, Chung JB, Kim KS. The efficacy of portal vein embolization prior to right extended hemihepatectomy for hilar cholangiocellular carcinoma: A retrospective cohort study. EJSO 2011: 37; 237-244.


ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ24
‰ŠátŠĚ‚É‚¨‚˘‚ÄŽcŠĚ—\”ő”\‚Ě—LŒř‚ČŽw•W‚Í‚ ‚é‚ŠH

CT‚É‚ć‚éŽcŠĚ—\’č‘ĚĎ‚Ě‘Ş’č‚ĆICG ”rŸ•ŽŽŒą‚͉ŠátŠĚ‚É‚¨‚Ż‚éŽcŠĚ—\”ő”\‚Ě—LŒř‚ČŽw•W‚Ĺ‚ ‚éBICG ”rŸ•ŽŽŒą‚Í’_ŠÇ‰Š‚Ě•š‘ś‚Ě‚Č‚˘Œ¸‰ŠŒă‚É‘Ş’č‚ľ•]‰ż‚ˇ‚ׂŤ‚Ĺ‚ ‚éB

„§“x1@ƒGƒrƒfƒ“ƒXƒŒƒxƒ‹C

‰đŕ

’_“šŠŕÇ—á‚ł́A•ÂÇŤ‰Šát‚É‚ć‚é’_`ŸT‘Ř‚Š‚ç—lX‚Č’ö“x‚ĚŠĚ—\”ő‚̒ቺ‚đ”F‚ß‚Ä‚˘‚é‚˝‚߁A‘ƒrƒŠƒ‹ƒrƒ“’l‚Č‚Ç’Pˆę‚ĚŒŒ‰tś‰ťŠw“IŒŸ¸‚ł͐łŠm‚ČŠĚ‹@”\•]‰ż‚͍˘“ď‚Ĺ‚ ‚éB

–{–M‚ł͉ŠátÇ—á‚â’_ŠÇ‰Š•š”­—á‚ɑ΂ľ‚Ä’_ŠÇƒhƒŒƒi[ƒW‚đs‚˘Œ¸‰Š‚ľ‚Ä‚Š‚çAŽcŠĚ—\”ő”\•]‰ż‚ľŠĚŘœ‚đs‚Á‚Ä‚˘‚éB‰ŠátŠĚ‚É‚¨‚˘‚Ä‘ƒrƒŠƒ‹ƒrƒ“’l‚Ş‚Ç‚ą‚܂Œቺ‚ľ‚˝‚çAŠĚŘœ‚đs‚¤‚Š–žŽŚ‚ľ‚˝•ń‚͏­‚Č‚˘‚ށA2.0mg/dl ‚܂Œቺ‚ˇ‚é‚Ě‚đ‘Ň‚ÂŽ{Ý‚Ş‘˝‚˘1-4jB

’_“šŠŕ‚Ĺ‚ÍL”ÍˆÍ‚ČŠĚŘœ‚Ş•K—v‚ČŠg‘ĺŠĚ—tŘœ‚Ş•K—v‚ČŽ–‚Ş‘˝‚­AÇ—Ⴒ‚Ć‚ÉŘœŠĚ—eĎ‚ŞˆŮ‚Č‚é‚˝‚߁AŽcŠĚ—\”ő”\‚đ•]‰ż‚ˇ‚éę‡‚É‚ÍŽcŠĚ—\’čŠĚ—eĎ‚đl—ś‚ˇ‚é•K—v‚Ş‚ ‚é5jBŒťŽž“_‚Ĺ‚ÍICG15R ’l1, 2, 3, 6j‚âAICG Á‘Ţ—Ś4j‚ŞŠĚ—\”ő”\‚̏d—v‚ČŽw•W‚Ć‚ľ‚čL‚­s‚í‚ę‚Ä‚˘‚éB

‰ŠátŠĚ‚ɑ΂ˇ‚éL”ÍˆÍŠĚ—tŘœŒă‚ł́Ap‘OŠĚ—\”ő‚â—\’čŽc‘śŠĚ‘ĚĎˆČŠO‚É‚ŕA’_ŠÇ‰ŠA‘Ď“™”\ˆŮíAp’†‘ĺ—ʏoŒŒAŒŒŠÇ‡•šŘœ‚âäX“ޏ\“ńŽw’°Řœ‚Ě•šŽ{‚Č‚Ç‚ŞpŽ€‚âŠĚ•s‘S‚Ě”­ś‚ɉe‹ż‚ľ3, 6, 7jAĹI“I‚ɉŠátŠĚ‚̍L”ÍˆÍŠĚ—tŘœ‚É‚¨‚Ż‚éŘœ‚ĚˆŔ‘SŤ‚𔝒股‚é‚ɂ́AŒÂ•Ę‚ĚÇ—á‚˛‚Ć‚É‘‡“I‚Č”ť’f‚đ‚š‚´‚é‚đ“ž‚Č‚˘B

ŽQl•śŒŁ

1j Seyama Y, Kubota K, Sano K, Noie T, Takayama T, Kosuge T, Makuuchi M. Long-term outcome of extended hemihepatectomy for hilar bile duct cancer with no mortakity and high survival rate. Ann Surg 2003; 238: 73-83.

2j Kawasaki S, Imamura H, Kobayashi A, Noike T, Miwa S, Miyagawa S. Results of surgical resection for patients with hilar bile duct cancer Application of extended hemihepatectomy after biliary drainage and hemihepatic portal vein embolization. Ann Surg 2003; 238: 84-92.

3j Suda K, Ohtsuka M, Ambiru S, Kimura F, Shimizu H, Yoshidome H, Miyazaki M. Risk factors of liver dysfunction after extended hepatic resection in biliary tract malignancies. Am J Surg 2009; 197: 752-8.

4j Yokoyama Y, Nishio H, Ebata T, Igami T, Sugawara G, Nagino M. Value of indocyanine green clearance of the future liver remnant in predicting outcome after resection for biliary cancer. Br J Surg 2010; 97: 1260-8.

5j Kubota K, Makuuchi M, Kusaka K, Kobayashi T, Miki K, Hasegawa K, Harihara Y, Takayama T. Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors. Hepatology 1997; 26: 1176-81.

6j Sano T, Shimada K, Sakamoto Y, Yamamoto J Yamasaki S, Kosuge T. One hundred two consecutive hepatobiliary resections for perihilar cholangiocarcinoma with zero mortality. Ann Surg 2006; 244: 240-247.

7j Nagino M, Kamiya J, Nishio H, Ebata T, Arai T, Nimura Y. Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and long-term follow-up. Ann Surg 2006; 243: 364-72.


ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ25
ŠĚ–ĺ•”Eă•”’_ŠÇŠŕ‚ɑ΂ľ”öó—t‡•šŘœ‚͍s‚¤‚ׂŤ‚ŠH

ŠĚ–ĺ•”Eă•”’_ŠÇŠŕ‚ɑ΂ľ‚ẮA”öó—t‡•šŘœ‚đŠÜ‚ީ̐؏œ‚đs‚¤‚ą‚Ć‚ĹŽĄ–üŘœ—Ś‚ĚŒüă‚¨‚ć‚Ń—\Œă‰„’ˇ‚ŞŠú‘Ň‚ł‚ę‚é‚˝‚߁AŒ´‘Ľ“I‚ɍs‚¤‚ׂŤ‚Ĺ‚ ‚éB

„§“x1@ƒGƒrƒfƒ“ƒXƒŒƒxƒ‹B

‰đŕ

”öó—t’_ŠÇŽ}‚͉đ–UŠw“I‚ɍś‰EŠĚŠÇ‡—Ź•”•t‹ß‚ɍ‡—Ź‚ˇ‚é‹ćˆć’_ŠÇŽ}‚Ĺ‚ ‚čAŠĚ–ĺ•”’_ŠÇŠŕ‚É‚¨‚˘‚Ă͍‚•p“xi31-98%j‚ɐZ‚Ş”F‚ß‚ç‚ę‚é‚Ć•ń‚ł‚ę1-5jAu”öó—tŘœ‚ÍŠĚ–ĺ•”’_ŠÇŠŕ‚ɑ΂ľ‚čŏŹŒŔs‚¤‚ׂŤŠĚŘœ‚Ĺ‚ ‚év‚ĆŒ‹˜_‚Ă‚Ż‚Ä‚˘‚é‚ŕ‚Ě‚ŕ‚ ‚é2jB‚ą‚ę‚ç‚Ě•ń‚É‚ć‚č–{–M‚Ĺ‚Í1990 ”N‘ăˆČ~AŠĚ–ĺ•”’_ŠÇŠŕ‚ɑ΂ľ‚Ä‚Í”öó—t‡•šŘœ‚Ş•W€“I‚ɍs‚í‚ę‚Ä‚Ť‚Ä‚¨‚čAŽĄ–üŘœ—Ś‚Í59-87%A5”Nś‘ś—Ś‚Í33-44%‚Ć•ń‚ł‚ę‚Ä‚˘‚é6-16jB

”ŠO‘‚É‚¨‚˘‚Ä‚ŕ–{–M‚đ’Ǐ]‚ˇ‚é‚悤‚ɁA2000 ”NˆČ~AŠĚ–ĺ•”’_ŠÇŠŕ‚ɑ΂ˇ‚é”öó—t‡•šŘœ‚Ě—L—pŤ‚ÉŠÖ‚ˇ‚é•ń‚Ş‚Ý‚ç‚ę‚éB‚˘‚¸‚ę‚ŕƒŒƒgƒƒXƒyƒNƒeƒBƒu‚ČŒŸ“˘‚Ĺ‚ ‚é‚ŕ‚̂́A”öó—t‡•šŘœ‚͈Ŕ‘S‚ÉŽ{s‰Â”\‚ŁAŽĄ–üŘœ—Ś‚¨‚ć‚ѐś‘ś—Ś‚đŒüă‚ł‚š‚é‚Ć•ń‚ł‚ę‚Ä‚˘‚é17-22jB

ˆę•űABismuth I Œ^‚ĚÇ—á‚Ĺ”öó—t’_ŠÇŽ}‚ÉŠŕZ‚đ”F‚ß‚Č‚˘ę‡‚ɂ́A”öó—t‚đ‰ˇ‘ś‚ľ‚˝ŠĚ–ĺ•”’_ŠÇŘœ‚É‚ÄŽĄ–üŘœ‰Â”\‚Čę‡‚Ş‚ ‚é‚Ş16jAp‘O‚É”öó—t’_ŠÇŽ}‚Ö‚ĚŠŕZ‚𐳊m‚ɐf’f‚ˇ‚é‚ą‚Ć‚Í˘“ď‚Ĺ‚ ‚čA”öó—t‚đ‰ˇ‘ś‚ľ‚˝ŠĚ–ĺ•”’_ŠÇŘœ‚Ě“K‰ž‚͐Td‚ɍs‚í‚ę‚é‚ׂŤ‚Ĺ‚ ‚éB

ŽQl•śŒŁ

1j Mizumoto R, Kawarada Y, and Suzuki H, Surgical treatment of hilar carcinoma of the bile duct. Surg Gynecol Obstet, 1986. 162: 153-158.

2j Nimura Y, Hayakawa N, Kamiya J, Kondo S, and Shionoya S, Hepatic segmentectomy with caudate lobe resection for bile duct carcinoma of the hepatic hilus. World J Surg, 1990. 14: 535-543; discussion 544.

3j Ogura Y, Mizumoto R, Tabata M, Matsuda S, and Kusuda T, Surgical treatment of carcinoma of the hepatic duct confluence: analysis of 55 resected carcinomas. World J Surg, 1993. 17: 85-92; discussion 92-83.

4j Sugiura Y, Nakamura S, Iida S, Hosoda Y, Ikeuchi S, Mori S, et al., Extensive resection of the bile ducts combined with liver resection for cancer of the main hepatic duct junction: a cooperative study of the Keio Bile Duct Cancer Study Group. Surgery, 1994. 115: 445-451.

5j Nimura Y, Hayakawa N, Kamiya J, Kondo S, Nagino M, and Kanai M, Hilar cholangiocarcinoma-surgical anatomy and curative resection. J Hepatobiliary Pancreat Surg, 1995. 2: 239-543.

6j Igami T, Nishio H, Ebata T, Yokoyama Y, Sugawara G, Nimura Y, et al., Surgical treatment of hilar cholangiocarcinoma in the "new era": the Nagoya University experience. J Hepatobiliary Pancreat Sci, 2010. 17: 449-454.

7j Miyazaki M, Kimura F, Shimizu H, Yoshidome H, Otuka M, Kato A, et al., One hundred seven consecutive surgical resections for hilar cholangiocarcinoma of Bismuth types Ⅱ , Ⅲ , IV between 2001 and 2008. J Hepatobiliary Pancreat Sci, 2010. 17: 470-475.

8j Unno M, Katayose Y, Rikiyama T, Yoshida H, Yamamoto K, Morikawa T, et al., Major hepatectomy for perihilar cholangiocarcinoma. J Hepatobiliary Pancreat Sci, 2010. 17: 463-469.

9j Hirano S, Kondo S, Tanaka E, Shichinohe T, Tsuchikawa T, Kato K, et al., Outcome of surgical treatment of hilar cholangiocarcinoma: a special reference to postoperative morbidity and mortality. J Hepatobiliary Pancreat Sci, 2010. 17: 455-462.

10j Sano T, Shimada K, Sakamoto Y, Yamamoto J, Yamasaki S, and Kosuge T, One hundred two consecutive hepatobiliary resections for perihilar cholangiocarcinoma with zero mortality. Ann Surg, 2006. 244: 240-247.

11j Seyama Y, Kubota K, Sano K, Noie T, Takayama T, Kosuge T, et al., Long-term outcome of extended hemihepatectomy for hilar bile duct cancer with no mortality and high survival rate. Ann Surg, 2003. 238: 73-83.

12j Kawasaki S, Imamura H, Kobayashi A, Noike T, Miwa S, and Miyagawa S, Results of surgical resection for patients with hilar bile duct cancer: application of extended hepatectomy after biliary drainage and hemihepatic portal vein embolization. Ann Surg, 2003. 238: 84-92.

13j Nimura Y, Kamiya J, Kondo S, Nagino M, Uesaka K, Oda K, et al., Aggressive preoperative management and extended surgery for hilar cholangiocarcinoma: Nagoya experience. J Hepatobiliary Pancreat Surg, 2000. 7: 155-162.

14j Tabata M, Kawarada Y, Yokoi H, Higashiguchi T, and Isaji S, Surgical treatment for hilar cholangiocarcinoma. J Hepatobiliary Pancreat Surg, 2000. 7: 148-154.

15j Kosuge T, Yamamoto J, Shimada K, Yamasaki S, and Makuuchi M, Improved surgical results for hilar cholangiocarcinoma with procedures including major hepatic resection. Ann Surg, 1999. 230: 663-671.

16j Miyazaki M, Ito H, Nakagawa K, Ambiru S, Shimizu H, Shimizu Y, et al., Aggressive surgical approaches to hilar cholangiocarcinoma: hepatic or local resection? Surgery, 1998. 123: 131-136.

17j Kow A W, Wook C D, Song S C, Kim W S, Kim M J, Park H J, et al., Role of Caudate Lobectomy in Type Ⅲ (A) and Ⅲ (B) Hilar Cholangiocarcinoma: A 15-year Experience in a Tertiary Institution. World J Surg, 2012. 36: 1112-1121.

18j Wahab M A, Sultan A M, Salah T, Fathy O, Elebidy G, Elshobary M, et al., Caudate Lobe Resection with Major Hepatectomy for Central Cholangiocarcinoma: Is it of Value? Hepatogastroenterology, 2012. 59: 321-324.

19j Liu C L, Fan S T, Lo C M, Tso W K, Lam C M, and Wong J, Improved operative and survival outcomes of surgical treatment for hilar cholangiocarcinoma. Br J Surg, 2006. 93: 1488-1494.

20j Dinant S, Gerhards M F, Busch O R, Obertop H, Gouma D J, and Van Gulik T M, The importance of complete excision of the caudate lobe in resection of hilar cholangiocarcinoma. HPB (Oxford), 2005. 7: 263-267.

21j Lee S G, Lee Y J, Park K M, Hwang S, and Min P C, One hundred and eleven liver resections for hilar bile duct cancer. J Hepatobiliary Pancreat Surg, 2000. 7: 135-141.

22j Gazzaniga G M, Filauro M, Bagarolo C, and Mori L, Surgery for hilar cholangiocarcinoma: an Italian experience. J Hepatobiliary Pancreat Surg, 2000. 7: 122-127.


ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ26
ŒŒŠÇZ—á‚ɑ΂ľ‚ÄŒŒŠÇ‡•šŘœ‚͍s‚¤‚ׂŤ‚ŠH

–ĺ–Ź‡•šŘœ—á‚́AŘœ•s”\—á‚É”äŠr‚ˇ‚é‚Ć—LˆÓ‚É—\Œă‚͗ǍD‚Ĺ‚ ‚čA–ĺ–Ź‡•šŘœ‚Í—L—p‚Ĺ‚ ‚é‰Â”\Ť‚Ş‚ ‚éB

„§“x2@ƒGƒrƒfƒ“ƒXƒŒƒxƒ‹C

ŠĚ“Ž–Ź‡•šŘœ‚Ě—Ő°“IˆÓ‹`‚́AŒť’iŠK‚Ĺ‚Í•s–žŠm‚Ĺ‚ ‚éB

„§“x‚Č‚ľ

‰đŕ
–ĺ–Ź‡•šŘœ

ŠĚ–ĺ•”’_ŠÇŠŕ‚ɑ΂ˇ‚é–ĺ–Ź‡•šŘœ‚Í–ĺ–Ź”ń‡•šŘœÇ—á‚ć‚č‚ŕ—\Œă‚Í•s—Ç‚Ĺ‚ ‚é‚ŞAˆę•”‚Ĺ’ˇŠúś‘ś‚މ”\‚Ĺ‚ ‚Á‚˝‚ą‚Ć‚âAŽîᇂ̐؏œ•s”\—á‚ć‚č‚Í—\Œă‚ޗǍD‚Ć‚Ě•ń‚Ş‘˝‚­”F‚ß‚ç‚ę‚é1-3jB‚˝‚žA–ĺ–Ź‡•šŘœ‚Ě‘OŒü‚Ť”äŠrŽŽŒą‚Ş‚ ‚é‚í‚Ż‚Ĺ‚Í‚Č‚­A‚Ü‚˝–ĺ–Ź‡•šŘœ—á‚͐؏œ•s”\—á‚Ć”äŠr‚ľ‚Ä—\Œă‚ޗǍD‚Ć‚ˇ‚é•ń‚É‚¨‚˘‚Ä‚ŕAŘœ•s”\—á‚Ě‘˝‚­‚Í–ĺ–ŹZ‚Ě‚˝‚ß‚ÉŘœ•s”\‚Ć‚Č‚Á‚˝‚í‚Ż‚Ĺ‚Í‚Č‚˘B‚ť‚¤‚ľ‚˝“_‚ł́A–ĺ–Ź‡•šŘœ‚ĚˆÓ‹`‚đ–ž‚ç‚Š‚É‚ˇ‚é\•Ş‚ȉȊw“IŞ‹’‚Í‚Č‚˘B‚ľ‚Š‚ľA–ĺ–Ź‡•šŘœ‚É‚ć‚Á‚ÄŞŽĄŘœ‚Ş‚Ĺ‚Ť‚éÇ—á‚Şˆę’萔‘śÝ‚ľAhigh volume center ‚Ĺ‚Í‚ť‚¤‚ľ‚˝Ç—á‚É”äŠr“IˆŔ‘S‚Š‚ϋɓI‚É–ĺ–Ź‡•šŘœ‚ލs‚í‚ęA‚Ü‚˝‚ť‚̐ŹŃ‚ŕ”ń‡•šŘœ—á‚Ć—LˆÓˇ‚Ş‚Č‚˘‚Ć‚ˇ‚é•ń‚ŕŽUŒŠ‚ł‚ę‚éB‚ą‚¤‚ľ‚˝ŽŔî‚đ“Ľ‚Ü‚ŚA„§“x‚Í2 ‚Ć‚ľ‚˝B

ŠĚ“Ž–Ź‡•šŘœ

ŠĚ“Ž–Ź‡•šŘœ‚ÉŠÖ‚ľ‚Ă͈Ŕ‘S‚ÉŽ{s‚Ĺ‚ŤAR0 Žčp‚މ”\‚Ĺ‚ ‚ę‚Η\Œă‰ü‘P‚ÉŒ‹‚т‚­‰Â”\Ť‚Ş‚ ‚é‚Ć‚Ě•ń4, 5j‚ƁAÝ‰@Ž€–S—Ś‚ŕ‚‚­Řœ•s”\—á‚Ć—\Œă‚Ş‚Š‚í‚ç‚Č‚˘‚Ć‚Ě•ń3j‚ŕ‚ ‚éBĹ‹ß‚ł́Aś‘¤ŠĚŘœ—á‚𒆐S‚Ć‚ľ‚˝“Ž–ĺ–Ź‡•šŘœ‚𔺂¤ŠĚ–ĺ•”’_ŠÇŠŕ‚ĚŒŸ“˘‚ĹÝ‰@Ž€–S—Ś‚ŕ’á‚­AR0 Řœ—Ś67%A5 ”Nś‘ś—Ś‚Ş30%‚Ć‚Ě•ń‚ŕ‚ ‚é6jB’_“šŠŕ‚ɑ΂ˇ‚éŠĚ“Ž–Ź‡•šŘœ‚Í‘˝”—á‚Ě•ń‚ޏ­‚Č‚­AŒťŽž“_‚Ĺ‚Í‚ť‚Ě—Ő°“IˆÓ‹`‚ɂ‚˘‚Ä‚ŕŽ^”Ű—ź˜_‚Ş‚ ‚éBˆČă‚Ě”wŒi‚đ‚Ó‚Ü‚ŚAŒťŽž“_‚ł͐„§“x‚͂‚Ż‚Č‚˘‚ą‚Ć‚Ć‚ľ‚˝B

ŽQl•śŒŁ

1j Ebata, T, Nagino M, Kamiya J, Uesaka K, Nagasaka T, Nimura Y. Hepatectomy with portal vein resection for hilar cholangiocarcinoma: audit of 52 consecutive cases Ann Surg 2003; 238: 720-727.

2j Igami T, Nishio H, Ebata T, Yokoyama Y, Sugawara G, Nimura Y, Nagino M. Surgical treatment of hilar cholangiocarcinoma in the gnew erah: the Nagoya University experience. J Hepatobiliary Pancreat Sci 2010; 17: 449-454.

3j Miyazaki M, Kato A, Ito H, Kimura F, Shimizu H, Ohtsuka M, Yosidome H, Yoshitomi H, Furukawa K, Nozawa S. Combined vascular resection in operative resection for hilar cholangiocarcinoma: does it work or not?. Surgery 2007; 141: 581-588.

4j Yamanaka N, Yasui C, Yamanaka J, Anmdo T, kuroda N, Maeda S, Ito T, Okamoto E. Left hemihepatectomy with microsurgical reconstruction of the right-sided hepatic vasculature: a strategy for preserving hepatic function in patients with proximal bile duct cancer. Langenbecks Arch Surg 2001; 386: 364-368.

5j Sakamoto Y, Sano T, Shimada K, et al. Clinical significance of reconstruction of the right hepatic artery for biliary malignancy. Langenbecks Arch Surg 2006; 391: 203-208.

6j Nagino M, Nimura Y, Nishio H, Ebata T, Igami T, Matsuhita M, Nishikimi N, Kamei Y. Hepatectomy with simultaneous resection of the portal vein and hepatic artery for advanced perihilar cholangiocarcinoma. An audit of 50 consecutive cases. Ann Surg 2010; 252: 115-123.


ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ27
’_ŠÇŠŕŘœŒă‚Ě—\ŒăˆöŽq‚͂ǂ̂悤‚Č‚ŕ‚Ě‚ŠH

’_ŠÇŘ—Ł’f’[‚¨‚ć‚Ń”—Ł–Ę‚Ĺ‚ĚŠŕ‚ĚˆâŽc‚Ě—L–łCƒŠƒ“ƒpß“]ˆÚ‚Ě—L–łC_ŒoŽüˆÍZ‚Ě—L–ł‚¨‚ć‚Ń–ĺ–ŹEŠĚ“Ž–Ź‚ւ̐Z‚É‚ć‚錌ŠÇ‡•šŘœ‚Ě—L–ł‚Č‚Ç‚Ş‚ ‚°‚ç‚ę‚éB‚˝‚ž‚ľC’_ŠÇŘ—Ł’f’[‚É‚¨‚Ż‚éŠŕˆâŽc‚ɂ͐ZŠŕ—zŤ‚Əă”ç“ŕŠŕ—zŤ‚Ć‚Ş‚ ‚čCZŠŕ—zŤ‚Ěę‡‚Í—\Œă•s—Ç‚Ĺ‚ ‚é‚ŞCă”ç“ŕŠŕ‚Ěę‡‚͔ӊú‹ÇŠÄ”­‚ĚƒŠƒXƒN‚Í‚ ‚é‚ŕ‚Ě‚Ě’ZŠú—\Œă‚Í”äŠr“I—ǍD‚Ĺ‚ ‚éB

„§“x‚Č‚ľ

‰đŕ

’_ŠÇŠŕ‚Ě‚Č‚Š‚Ĺ‚ŕ—\Œă•s—Ç‚Ć‚˘‚í‚ę‚éă•”CŠĚ–ĺ•”’_ŠÇŠŕ‚̐؏œŒă‚Ě—\ŒăˆöŽq‚ɂ‚˘‚Ä‘˝•Ď—ʉđÍ‚đs‚Á‚˝˜_•ś•ń‚đ‚Ü‚Ć‚ß‚˝Œ‹‰Ę1j‚Š‚ç‚́A11 ‚Ě•ń‚Ě‚¤‚ż9 ‚‚ފŕˆâŽc‚Ě—L–ł‚đ‚ ‚°‚Ä‚¨‚čC—\Œă‚ÉĹ‚ŕ‘ĺ‚Ť‚­‰e‹ż‚đ‹y‚Ú‚ˇˆöŽq‚Ć‚ł‚ęA“Á‚ɁAŘœ’f’[‚¨‚ć‚Ń”—Ł–Ę‚ÉŠŕˆâŽc‚đ”F‚ß‚Č‚˘Žčp‚đ‹s‚ˇ‚é‚ą‚Ć‚Ěd—vŤ‚Ş‘˝”‚Ě˜_•ś‚ŏq‚ׂç‚ę‚Ä‚˘‚é2`7jB‚ć‚Á‚āAŽĄ–üŘœ‚đ–ÚŽw‚ˇ‚ą‚Ć‚ŞĹ‚ŕd—v‚Ĺ‚ ‚é8jB‚˝‚ž‚ľC’_ŠÇŘ—Ł’f’[‚É‚¨‚Ż‚éŠŕˆâŽc‚ɂ͐ZŠŕ—zŤ‚Əă”ç“ŕŠŕ—zŤ‚Ć‚Ş‚ ‚čCZŠŕ—zŤ‚Ěę‡‚Í—\Œă•s—Ç‚Ĺ‚ ‚é‚ŞCă”ç“ŕŠŕ‚Ěę‡‚͔ӊú‹ÇŠÄ”­‚ĚƒŠƒXƒN‚Í‚ ‚é‚ŕ‚Ě‚Ě’ZŠú—\Œă‚ɂ͉e‹ż‚ľ‚Č‚˘‚ą‚Ć‚Ş•ń‚ł‚ę‚Ä‚˘‚é9-14jB

ŽĄ–üŘœ—á‚É‚¨‚˘‚Ă̓Šƒ“ƒpß“]ˆÚ‚Ě—L–ł‚Ş—\Œă‚É‘ĺ‚Ť‚­‰e‹ż‚ľ‚Ä‚˘‚é2-5, 8, 15, 16jBƒŠƒ“ƒpß“]ˆÚ—á‚Ě—\Œă‚Í•K‚¸‚ľ‚ŕˆŤ‚­‚Č‚˘‚Ć‚Ě•ń‚ŕ‚ ‚é‚Ş4, 8jA’P•Ď—ʁC‘˝•Ď—ʉđÍ‚ĚŒ‹‰Ę‚Š‚ç‚Ý‚Ä‚ŕƒŠƒ“ƒpß“]ˆÚ‚Ě—L–ł‚ŞŘœŒă‚̏d—v‚Č—\ŒăˆöŽq‚ƍl‚Ś‚ç‚ę‚éB

‚Ü‚˝A_ŒoŽüˆÍZ‚Ě—L–łA“÷Šá“I–ĺ–ŹZ‚¨‚ć‚ŃŒŒŠÇ‡•šŘœ‚ŕ—\Œă•s—LjöŽq‚Ć‚ľ‚Ä•ń‚ł‚ę‚Ä‚˘‚é2, 6, 17jB

’†‰ş•”’_ŠÇŠŕ‚ŕŠĚ–ĺ•”’_ŠÇŠŕ‚Ć“Ż—l‚ÉŽĄ–üŘœ‚މ”\‚Ĺ‚ ‚Á‚˝‚Š”Ű‚Š‚Ş—\Œă‚ÉĹ‚ŕ‘ĺ‚Ť‚­‰e‹ż‚đ‹y‚Ú‚ˇ18, 19jBƒŠƒ“ƒpß“]ˆÚ18-21j‚âäXZ21j‚ŕd—v‚Č—\ŒăˆöŽq‚Ĺ‚ ‚é‚Ć•ń‚ł‚ę‚Ä‚˘‚éBƒŠƒ“ƒpß“]ˆÚ—zŤŒÂ”‚Ş2 ŒÂ‚Ü‚Ĺ‚ĚÇ—á‚ł́CŽĄ–üŘœ‚É‚ć‚č—ǍD‚Č—\Œă‚ŞŠú‘Ň‚Ĺ‚Ť‚é‚Ć‚Ě•ń‚ŕ‚ ‚é19, 20jB

ˆČăC’_ŠÇŠŕ‚É‚¨‚˘‚Ä—\Œă‚É‘ĺ‚Ť‚­‰e‹ż‚đ‹y‚Ú‚ˇˆöŽq‚Ć‚ľ‚Ä‚ÍŠŕˆâŽc‚Ě–ł‚˘ŽĄ–üŘœ‚Ĺ‚ ‚Á‚˝”Ű‚Š‚Ĺ‚ ‚čCŘœ•W–{‚ĚÚ×‚ČŒŸő‚ޏd—v‚Ĺ‚ ‚éBŘœ’f’[‚┍—Ł–Ę‚ÉŠŕˆâŽc‚Ş‚Ý‚ç‚ę‚éÇ—á‚ ‚邢‚̓Šƒ“ƒpß“]ˆÚ—zŤ—á‚Ĺ‚ÍÄ”­‚đ‚Ť‚˝‚ˇ‰Â”\Ť‚ލ‚‚­CŒľd‚ČŒo‰ßŠĎŽ@‚Ş•K—v‚Ĺ‚ ‚čCi“Wó‹ľ‚ɉž‚ś‚˝pŒă‚ĚŽĄ—Ð헪‚đl—ś‚ˇ‚é•K—v‚Ş‚ ‚éB

ŽQl•śŒŁ

1j Kondo S, Hirano S, Ambo Y, Tanaka E, Okushiba S, Morikawa T, et al. Forty consecutive resections of hilar cholangiocarcinoma with no postoperative mortality and no positive ductal margins: results of a prospective study. Ann Surg 2004; 240: 95-101.

2j Klempnauer J, Ridder GJ, Werner M, Weimann A, Pichlmayr R. What constitutes long-term survival after surgery for hilar cholangiocarcinoma? Cancer 1997; 79: 26-34.

3j Pichlmayr R, Weimann A, Klempnauer J, Oldhafer KJ, Maschek H, Tusch G, et al. Surgical treatment in proximal bile duct cancer. A single-center experience. Ann Surg 1996; 224: 628-638.

4j ‹{ěGˆęAÎŒ´@TA–xŒű–ž•FA‚“c’‰ŒhAź–쐳‹IA‚č@Œ’A‘ź. ’_“šŠŕŽćˆľ‚˘‹K–ń‚ÉŠî‚Ă‚­’_“šŠŕ“o˜^Ç—á‚̏WŒv: ŠĚ–ĺ•”’_ŠÇŠŕ‚𒆐S‚É. ŠĚ’_äX 2005; 50: 415-425.

5j Kosuge T, Yamamoto J, Shimada K, Yamasaki S, Makuuchi M. Improved surgical results for hilar cholangiocarcinoma with procedures including major hepatic resection. Ann Surg 1999; 230: 663-671.

6j Su CH, Tsay SH, Wu CC, Shyr YM, King KL, Lee CH, et al. Factors influencing postoperative morbidity, mortality, and survival after resection for hilar cholangiocarcinoma. Ann Surg 1996; 223: 384-394.

7j Sugiura Y, Nakamura S, Iida S, Hosoda Y, Ikeuchi S, Mori S, et al. Extensive resection of the bile ducts combined with liver resection for cancer of the main hepatic duct junction: a cooperative study of the Keio Bile Duct Cancer Study Group. Surgery 1994; 115: 445-451.

8j Nimura Y, Kamiya J, Kondo S, Nagino M, Uesaka K, Oda K, et al. Aggressive preoperative management and extended surgery for hilar cholangiocarcinoma: Nagoya experience. J Hepatobiliary Pancreat Surg 2000; 7: 155-162.

9j Wakai T, Shirai Y, Moroda T, Yokoyama N, Hatakeyama K. Impact of ductal resection margin status on long-term survival in patients undergoing resection for extrahepatic cholangiocarcinoma. Cancer 2005; 103: 1210-1216.

10j Sasaki R, Takeda Y, Funato O, Nitta H, Kawamura H, Uesugi N, et al. Significance of ductal margin status in patients undergoing surgical resection for extrahepatic cholangiocarcinoma. World J Surg 2007; 31: 1788-1796.

11j Ojima H, Kanai Y, Iwasaki M, Hiraoka N, Shimada K, Sano T, et al. Intraductal carcinoma component as a favorable prognostic factor in biliary tract carcinoma. Cancer Sci 2009; 100: 62-70.

12j Igami T, Nagino M, Oda K, Nishio H, Ebata T, Yokoyama Y, et al. Clinicopathologic study of cholangiocarcinoma with superficial spread. Ann Surg 2009; 249: 296-302.

13j Nakanishi Y, Kondo S, Zen Y, Yonemori A, Kubota K, Kawakami H, et al. Impact of residual in situ carcinoma on postoperative survival in 125 patients with extrahepatic bile duct carcinoma. J Hepatobiliary Pancreat Sci 2010; 17: 166-173.

14j Higuchi R, Ota T, Araida T, Kobayashi M, Furukawa T, Yamamoto M. Prognostic relevance of ductal margins in operative resection of bile duct cancer. Surgery 2010; 148: 7-14.

15j Nagakawa T, Kayahara M, Ikeda S, Futakawa S, Kakita A, Kawarada H, et al. Biliary tract cancer treatment: results from the Biliary Tract Cancer Statistics Registry in Japan. J Hepatobiliary Pancreat Surg 2002; 9: 569-575.

16j Seyama Y, Kubota K, Sano K, Noie T, Takayama T, Kosuge T, et al. Long-term outcome of extended hemihepatectomy for hilar bile duct cancer with no mortality and high survival rate. Ann Surg 2003; 328: 73-83.

17j Bhuiya MR, Nimura Y, Kamiya J, Kondo S, Fukata S, Hayakawa N, et al. Clinicopathologic studies on perineural invasion of bile duct carcinoma. Ann Surg 1992; 215: 344-349.

18j Kayahara M, Nagakawa T, Ohta T, Kitagawa H, Tajima H, Miwa K. Role of nodal involvement and the periductal soft-tissue margin in middle and distal bile duct cancer. Ann Surg 1999; 229: 76-83.

19j Yoshida T, Matsumoto T, Sasaki A, Morii Y, Aramaki M, Kitano S. Prognostic factors after pancreatoduodenectomy with extended lymphadenectomy for distal bile duct cancer. Arch Surg 2002; 137: 69-73.

20j Murakami Y, Uemura K, Hayashidani Y, Sudo T, Ohge H, Sueda T. Pancreatoduodenectomy for distal cholangiocarcinoma: prognostic impact of lymph node metastasis. World J Surg 2007; 31: 337-342.

21j Cheng Q, Luo X, Zhang B, Jiang X, Yi B, Wu M. Distal bile duct carcinoma: prognostic factors after curative surgery. A series of 112 cases. Ann Surg Oncol 2007; 14: 1212-1219.


ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ28
’_”XŠŕ‚đ‹^‚¤Ç—á‚ɑ΂ľ‚Ä‚Í• o‹ž‰ş’_”X“Eop‚Ĺ‚Í‚Č‚­ŠJ• ’_”X“Eop‚đs‚¤‚ׂŤ‚ŠH

’_”XŠŕ‚đ‹­‚­‹^‚¤Ç—á‚ɑ΂ľ‚Ä‚ÍŒ´‘Ľ“I‚ÉŠJ• ’_”X“Eop‚đs‚¤‚ׂŤ‚Ĺ‚ ‚éB

„§“x1@ƒGƒrƒfƒ“ƒXƒŒƒxƒ‹C

‰đŕ

• o‹ž‰ş’_”X“Eop; LCilaparoscopic cholecystectomyj‚́AĄ“ú‚Ĺ‚Í’áNPpŽŽ‚Ć‚ľ‚čL‚­•‹y‚ľA’_”XŒ‹ÎÇ‚ɑ΂ľ‚ẮA‘ćˆę‘I‘đ‚Ć‚Č‚Á‚Ä‚˘‚éB‹ß”N‚ł́A‘S’_囊“Eop‚Ě‚¤‚żALC ‚̐č‚ß‚é”ä—Ś‚Í80“‚đ‰z‚ŚA’_”XŠŕ‹^f—á‚ɑ΂ľ‚Ä‚ŕ‚ť‚Ě“K‰ž‚đŠg‘傡‚éŒXŒü‚đ”F‚ß‚é1jB‚ľ‚Š‚ľ‚Č‚Ş‚çA’_”XŠŕ‚ÉLC ‚đ“K‰ž‚Ć‚ˇ‚éę‡A’_”X‘š‚É”ş‚¤• o“ŕ‚Ö‚Ě’_`˜Ro‚ĚŒ‹‰Ę‚Ć‚ľ‚Ä‚ĚPSRiport site recurrencej‚â• –ŒÄ”­‚Í‘ĺ‚Ť‚Č–â‘č‚ĆŒž‚í‚´‚é‚Ć“ž‚Č‚˘2-4jBLC Œă‚É”­ŒŠ‚ł‚ę‚˝‹ô”­’_囊Šŕ‚É‚¨‚˘‚āAPSR ‚â• –ŒÄ”­‚Ě”­ś—Ś‚Í10-18“‚ƍ‚—Ś‚Ĺ‚ ‚č5-9jA‚Ü‚˝AÄ”­‚Ü‚Ĺ‚ĚŠúŠÔ‚ŕ6`10 ƒ–ŒŽ‚Ć’Z‚˘ŒXŒü‚Ş‚ ‚é‚Ć•ń‚ł‚ę‚Ä‚˘‚é6-8jB‚ą‚ę‚́Ap’†‚Ě’_囊úE‚É‚ć‚čŠŕ×–E‚đŠÜ‚Ţ’_`‚Ş• o“ŕ‚ÉŽU•z‚ł‚ę‚éA’_”X‚đ‘ĚŠO‚É“Eo‚ˇ‚éŰ‚Ěƒ|[ƒg‘}“ü•”‚މ˜ő‚ł‚ę‚₡‚˘‚Č‚Ç‚Ş‚ť‚Ě‘ĺ‚Ť‚Č—vˆö‚Ć‚ł‚ę‚é‚ŞA’_`˜RoˆČŠO‚ÉŽîᇂ̐ś•¨Šw“IŤŽż‚â•aŠúCŽčpŽč‹Z‚ł‚ç‚É‚Í‹C• ˆł‚â’YŽ_ƒKƒX‚̐ś‘Ě‚âŽîᇍזE‚ɑ΂ˇ‚é‰e‹ż‚Č‚Ç‚ŞŠÖ—^‚ľ‚Ä‚˘‚é‚Ć‚ŕl‚Ś‚ç‚ę‚Ä‚˘‚é6jB

‚ť‚Ěˆę•ű‚ŁA‹ß”N‚ł́A‹ô”­’_”XŠŕ‚ɑ΂ľ‚Ä‚ÍLC ‚ĆŠJ• ’_”X“Eop; OCiopen cholecystectomyj‚Ě—źŒQŠÔ‚É‚¨‚˘‚ÄŞŽĄŽčp‚đ•t‰Á‚ˇ‚ę‚΁AŽčpŹŃ‚É—LˆÓˇ‚Í‚Č‚­10-13jAŹ•a•Ď‚Ě•a—f’f‚đŠm’č‚ľŽĄ—Ă•űj‚đŒˆ’č‚ˇ‚é‚Ě‚É—L—p‚Ĺ‚ ‚é‚Ć‚ˇ‚é•ń‚ŕ”F‚ß‚ç‚ę‚Ä‚˘‚é‚Ě‚ŕŽ–ŽŔ‚Ĺ‚ ‚é10jB‚ľ‚Š‚ľ‚Č‚Ş‚çA’ʏí‚ĚLC ‚Ĺ‚Í•a•Ď‚Ş‹Ř‘w‚đ‰z‚Ś‚Ä‚˘‚ę‚΁AŘ—Ł–Ę‚ÉŠŕ‚Ş˜IoAˆâŽc‚ˇ‚é‰Â”\Ť‚Ş‚ ‚éB‚Ü‚˝A—˜_“I‚ÉLC ‚Ě“K‰ž‚Ć‚Č‚č“ž‚鑁Šú•a•Ďi[’B“xmp‚܂Łj‚̏p‘Of’f”\‚ÍMDCTAEUS ‚đ‹ěŽg‚ľ‚Ä‚ŕ–ń37%‚É‚ˇ‚Ź‚Č‚˘‚Ć•ń‚ł‚ę‚Ä‚˘‚é14jB‚ľ‚˝‚Ş‚Á‚āA­‚Č‚­‚Ć‚ŕ’_”X°•”‚É‚ ‚é’_”XŠŕ‚Ş‹^‚í‚ę‚é’_”X•Ç”ěŒúŤ•a•Ď‚â’_”Xƒ|ƒŠ[ƒv•a•Ď‚É‚ÍLC ‚Í“K‰ž‚Ć‚ˇ‚é‚ׂŤ‚Ĺ‚Í‚Č‚˘B‚Ü‚˝A• o‹ž‰ş‚ĚŞŽĄŘœ‚Ć‚ľ‚Ä’_”XŠŕ‚ɑ΂ˇ‚郊ƒ“ƒpßŠs´‚â’_”X°‚đ‡•šŘœ‚ˇ‚épŽŽ‚Ě•ń‚ŕ‚Ý‚ç‚ę‚é‚Ş15jCˆŔ’č‚ľ‚˝Žč‹Z‚ŞŠm—§‚ł‚ę‚Ä‚˘‚é‚í‚Ż‚Ĺ‚Č‚­CƒŠƒ“ƒpßŠs´‚̐¸“x‚ŕ•s–ž‚Ĺ‚ ‚čCŒťŽž“_‚ł͐„§‚ł‚ę‚éŽčp‚Ĺ‚Í‚Č‚˘B‚ć‚Á‚āAŒťŽž“_‚ł́A’_囊 Šŕ‚đ‹^‚¤Ç—á‚ɑ΂ľ‚ẮAŒ´‘Ľ‚Ć‚ľ‚ÄOC ‚đs‚¤‚ׂŤ‚ŁA’_”XŠŕ‚đ‹^‚¤Ç—á‚ɑ΂ˇ‚é• o‹ž‰şŽčp‚ɂ‚˘‚Ä‚ÍÚ×‚Čp‘Of’f‚Ě‚ŕ‚Ć‚É\•Ş‚ČƒCƒ“ƒtƒH[ƒ€ƒhƒRƒ“ƒZƒ“ƒg‚đs‚Á‚˝ă‚Ĺ—Ő°ŽŽŒą‚Ć‚ľ‚čs‚¤‚ׂŤ‚Ĺ‚ ‚éB

ŽQl•śŒŁ

1j “ú–{“ŕŽ‹‹žŠO‰ČŠw‰ď. “ŕŽ‹‹žŠO‰ČŽčp‚ÉŠÖ‚ˇ‚éƒAƒ“ƒP[ƒg’˛¸@‘ć10 ‰ńWŒvŒ‹‰Ę•ń. “ú–{“ŕŽ‹‹žŠO‰ČŠw‰ďŽGŽ 2010; 15: 565-679.

2j Wullstein C, Woeste G, Barkhausen S, et al. Do complications related to laparoscopic cholecystectomy influence the prognosis of gallbladder cancer?. Surg Endosc 2002; 16: 828-32.

3j Jin K, Lan H, Zhu T, et al. Gallbladder carcinoma incidentally encountered during laparoscopic cholecystectomy: how to deal with it. Clin Transl Oncol 2011; 13: 25-33.

4j Reddy YP, Sheridan WG. Port-site metastasis following laparoscopic cholecystectomy: a review of the literature and a case report. Eur J Surg Oncol 2000; 26: 95-102.

5j Wakai T, Shirai Y, Hatakeyama K. Radical second resection prodides survival benefit for patients with T2 gallbladder carcinoma first discovered after laparoscopic cholecystectomy. World J Surg 26: 867-871, 2002.

6j Paolucci V, Schaeff B, Schneider M, Gutt C. Tumor seeding following laparoscopy: international survey. World J Surg 1999; 23: 989-95.

7j Lundberg O, Kristoffersson A. Port site metastases from gallbladder cancer after laparoscopic cholecystectomy. Results of a Swedish survey and review of published reports. Eur J Surg 1999; 165: 215-22.

8j Z'graggen K, Birrer S, Maurer CA, et al. Incidence of port site recurrence after laparoscopic cholecystectomy for preoperatively unsuspected gallbladder carcinoma. Surgery 1998; 124: 831-8.

9j Ouchi K, Mikuni J, Kakugawa Y; Organizing Committee, The 30th Annual Congress of the Japanese Society of Biliary Surgery. Laparoscopic cholecystectomy for gallbladder carcinoma: results of a Japanese survey of 498 patients. J Hepatobiliary Pancreat Surg 2002; 9: 256-60.

10j Yoshida T, Matsumoto T, Sasaki A, et al. Laparoscopic cholecystectomy in the treatment of patients with gallbladder cancer. J Am Coll Surg 191: 158-163,2000.

11j Whalen GF, Bird I, Tanski, et al. Laparoscopic cholecystectomy does not demonstrably decease survival of patients with serendipitously treated gallbladder cancer. J Am Coll Surg 192: 189-95, 2001.

12j Sarli L, Contini S, Sansebastiano G, et al. Does laparoscopic cholecystectomy worsen the prognosis of unsuspected gallbladder cancer? Arch Surg 2000; 135: 1340-4.

13j de Aretxabala XA, Roa IS, Mora JP, et al. Laparoscopic cholecystectomy: its effect on the prognosis of patients with gallbladder cancer. World J Surg 2004; 28: 544-7.

14j Kokudo N, Makuuchi M, Natori T, et al. Strategies for surgical treatment of gallbladder carcinoma based on information available before resection. Arch Surg 2003; 138: 741-50.

15j ”’•”‘˝‰ÂŽjA“ú”ä‘ב˘AĄˆä’B˜YA‘ź. ƒŠƒ“ƒpßŠs´‚𔺂Á‚˝• o‹ž‰ş’_”XŠŕŞŽĄŽčp. “ú–{“ŕŽ‹‹žŠO‰ČŠw‰ďŽGŽ 2003; 8: 525-30.


ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ29
’_囊“EoŒă‚ɐ[’B“xssˆČă’_囊Šŕ‚Ş”ť–ž‚ľ‚˝ę‡‚ɒljÁŘœ‚Í•K—v‚ŠH

ˆęŠú“IA‚Č‚˘‚ľ‚́A“ńŠú“I’ljÁŞŽĄp‚đl—ś‚ˇ‚ׂŤ‚Ĺ‚ ‚éB

„§“x1@ƒGƒrƒfƒ“ƒXƒŒƒxƒ‹C

‰đŕ

’_”XŒ‹ÎÇ‚Ȃǂ̗ǐŤ’_”XŽžŠł‚̐f’f‚Ě‚ŕ‚Ć• o‹ž‰ş‚ ‚邢‚́AŠJ• ’_”X“Eop‚ލs‚í‚ęA‚ť‚ĚŒă‚Ě•a—‘gDŠw“IŒŸő‚ŁA‰‚ß‚Ä’_囊Šŕ‚Ɛf’f‚ł‚ę‚é‹ô”­’_”XŠŕ‚Ě•p“x‚Í0.3-1.0%‚Ć•ń‚ł‚ę‚Ä‚˘‚é1-4jB

•Ç[’B“x‚Ş•W–{‘SŠ„‚ĚŒł‚Ĺ‚Ě•a—f’făAm, mp ‚ƏpŒă‚É”ť–ž‚ľ‚˝Ç—á‚ɑ΂ľ‚Ă͒ljÁŘœ‚đ—v‚ł‚Č‚˘‚ށAss ‚ɐZ‚ľ‚˝pT2 ’_”XŠŕ‚É‚¨‚˘‚ẮA–ŹŠÇNPA_ŒoŽüˆÍZ‚đ‚—Ś‚É”F‚߁A‚ł‚ç‚ɁAƒŠƒ“ƒpß“]ˆÚ—zŤ—Ś‚ŕ‚—Ś‚É”F‚ß‚é‚Ć‚ł‚ę5-11jAss ˆČă‚ĚÇ—á‚ɑ΂ľ‚Ä‚Í•K—v‚ɉž‚ś‚˝ŠĚŘœAƒŠƒ“ƒpßŠs´‚𔺂¤’ljÁŞŽĄŘœ‚đŽ{s‚ˇ‚ׂŤ‚Ĺ‚ ‚éBp’†‚ɐv‘Ź‘gDf‚É‚Äss ’_囊Šŕ‚Ɛf’f‚ł‚ę‚˝Ű‚ɂ́AˆęŠú“I‚ɒljÁŞŽĄŘœ‚đs‚¤‚Š”Ű‚Š‚́Ap’†v‘Ź‘gDf‚̐łŠmŤApŽŇ‚̒ljÁŞŽĄŘœ‚̏pŽŽ‚ɑ΂ˇ‚éKn“x‚Č‚Ç‚Ě‚˘‚­‚‚Š‚Ě–â‘č‚ŕ‚ ‚éB–{–M‚Ě‘S‘“o˜^WŒv—á‚Ě•ń‚É‚ć‚é‚ƁAˆęŠú“IŞŽĄŘœ—á‚Ć30 “úˆČ~‚ÉŞŽĄŘœ‚ŞŽ{s‚ł‚ę‚˝ŒQ‚Ć‚ĚŠÔ‚ÉpŒă‚̐ś‘ś—Ś‚É—LˆÓˇ‚Í”F‚ß‚Č‚Š‚Á‚˝12jB‚ľ‚˝‚Ş‚Á‚āA“ńŠú“IŞŽĄŽčp‚Ĺ‚ŕ”äŠr“I—ǍD‚ȐŹŃ‚Ş•ń‚ł‚ę‚Ä‚¨‚čA\•Ş‚ȏ€”ő‚Ě‚ŕ‚ƁAˆŔ‘S‚ɒljÁŞŽĄŘœ‚đs‚Ś‚Ηǂ˘B‚ł‚ç‚ɏ‰‰ńA• o‹ž‰ş’_”X“Eop‚Ş‚Č‚ł‚ę‚˝ę‡‚́APSRiport site recurrencej‚Ě–â‘č‚ŕ–ž‚ç‚Š‚É‚Č‚Á‚Ä‚Ť‚Ä‚¨‚čA’ljÁŘœ‚ĚŰ‚É‚Íƒ|[ƒgŽh“ü•”‚̐؏œ‚ŕl—ś‚ˇ‚ׂŤ‚Ĺ‚ ‚낤13jB‚˝‚žA’ljÁŞŽĄŘœŒă‚̐ŹŃ‚́A“–‘R‚Č‚Ş‚çAT Stage ‚ލ‚‚˘Ç—á‚ł́A“ńŠú“IŽčp‚ĚŰ‚ĚŠO‰ČŘœ—ŚA‚ł‚ç‚ɂ́AŘœŒă‚Ě‚T”Nś‘ś—Ś‚Í’á‚­A—\Œă‚Í•s—Ç‚Ć‚Č‚ç‚´‚é“ž‚Č‚˘12, 14-16jB

ŽQl•śŒŁ

1j Varshney S, Buttirini G, Gupta R. Incidental carcinoma of the gallbladder. Eur J Surg Oncol. 2002; 28: 4-10.

2j Zhang WJ, Xu GF, Zou XP, et al. Incidental gallbladder carcinoma diagnosed during or after laparoscopic cholecystectomy. World J Surg. 2009; 33: 2651-6.

3j Yamamoto H, Hayakawa N, Kitagawa Y, et al. Unsuspected gallbladder carcinoma after laparoscopic cholecystectomy. J Hepatobiliary Pancreat Surg. 2005; 12: 391-8.

4j Choi SB, Han HJ, Kim CY, et al. Incidental gallbladder cancer diagnosed following laparoscopic cholecystectomy. World J Surg. 2009; 33: 2657-63.

5j Suzuki S, Yokoi Y, Kurachi K, Inaba K, Ota S, Azuma M, Konno H, Baba S, Nakamura S. Appraisal of surgical treatment for pT2 gallbladder carcinomas. World J Surg. 2004; 28: 160-165.

6j Wakai T, Shirai Y, Yokoyama N, Ajioka Y, Watanabe H, Hatakeyama K. Depth of subserosal invasion predicts long-term survival after resection in patients with T2 gallbladder carcinoma. Ann Surg Oncol. 2003; 10: 447-454.

7j Shimizu Y, Ohtsuka M, Ito H, Kimura F, Shimizu H, Togawa A, Yoshidome H, Kato A, Miyazaki M. Should the extrahepatic bile duct be resected for locally advanced gallbladder cancer? Surgery. 2004; 136: 1012-1017.

8j ‘ć34 ‰ń“ú–{’_“šŠO‰ČŒ¤‹†‰ďƒAƒ“ƒP[ƒg’˛¸•ń. ’_囊ŠŕŠO‰ČŽĄ—Ă‚ĚŒť‹ľ. 2005.

9j Choi SB, Han HJ, Kim CY, et al. Surgical outcomes and prognostic factors for T2 gallbladder cancer following surgical resection. J Gastrointest Surg 2010; 14: 668-78.

10j Chijiiwa K, Nakano K, Ueda J, Noshiro H, Nagai E, Yamaguchi K, Tanaka M. Surgical treatment of patients with T2 gallbladder carcinoma invading the subserosal layer. J Am Coll Surg. 2001; 192: 600-607.

11j Schauer RJ, Meyer G, Baretton G, Schildberg FW, Rau HG. Prognostic factors and long-term results after surgery for gallbladder carcinoma: a retrospective study of 127 patients. Langenbecks Arch Surg. 2001; 386: 110-117.

12j Ouchi K, Mikuni J, Kakugawa Y; Organizing Committee, The 30th Annual Congress of the Japanese Society of Biliary Surgery. Laparoscopic cholecystectomy for gallbladder carcinoma: results of a Japanese survey of 498 patients. J Hepatobiliary Pancreat Surg. 2002; 9: 256-260.

13j Steinert R, Nestler G, Sagynaliev E, et al. Laparoscopic cholecystectomy and gallbladder cancer. J Surg Oncol 2006 15; 93: 682-9.

14j Shirai Y, Yoshida K, Tsukada K, Muto T. Inapparent carcinoma of the gallbladder. An appraisal of a radical second operation after simple cholecystectomy. Ann Surg. 1992; 215: 326-331.

15j Shukla PJ, Barreto G, Kakade A, et al. Revision surgery for incidental gallbladder cancer: factors influencing operability and further evidence for T1b tumours. HPB (Oxford) 2008; 10: 43-7.

16j Hueman MT, Vollmer CM Jr, Pawlik TM. Evolving treatment strategies for gallbladder cancer. Ann Surg Oncol 2009; 16: 2101-15.


ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ30
’_”XŠŕŘœŒă‚Ě—\ŒăˆöŽq‚͂ǂ̂悤‚Č‚ŕ‚Ě‚ŠH

’_”XŠŕ‚̐؏œŒă‚Ě—\ŒăˆöŽq‚ɂ‚˘‚Ä‚Í‘˝‚­‚Ě•ń‚Ş‚ ‚čA‰ŠátA•Ç[’B“xAƒŠƒ“ƒpß“]ˆÚAŠĚZ, ŠĚŠO’_ŠÇZAŠĚ\“ńŽw’°ŠÔ–ŒZAŽîᇕމť“xAŞŽĄ“xiŘœ’f’[Šŕ—zŤjAZŤŽîᇁAƒŠƒ“ƒpŠÇZAss Z‹——ŁA_ŒoŽüˆÍZ‚Ş‚ ‚°‚ç‚ę‚éB

„§“x‚Č‚ľ

‰đŕ

’_”XŠŕ‚̐؏œŒă‚Ě—\ŒăˆöŽq‚ÉŠÖ‚ľ‚ẮAŠłŽŇˆöŽqAŽîᇈöŽqAŽĄ—ĂˆöŽqAś•¨Šw“IˆöŽq‚Č‚Ç‘˝‚­‚Ě•ń‚Ş‚Ý‚ç‚ę‚éBŠłŽŇˆöŽq‚Ć‚ľ‚ẮA”N—îi70 ‚Ü‚˝‚Í65 ÎˆČăjAŤ•Ęi’jŤj‚Ş—\Œă•s—LjöŽq‚Ć‚ľ‚Ä‹“‚°‚ç‚ę‚Ä‚˘‚é1, 2jB‚Ü‚˝‰Šát‚Ĺ”­ŒŠ‚ł‚ę‚˝’_”XŠŕ‚âp‘O‚̉ŠÇŠŒŠ‚ŕ—\Œă•s—Ç‚Ć‚ł‚ę‚Ä‚˘‚é3, 4jB

ŽîᇈöŽq‚Ě‘ă•\“I‚Č‚ŕ‚Ě‚Ş•Ç[’B“x‚Ĺ‚ ‚é5-7jBUICC staging manualA–{–M‚Ě’_“šŠŕŽćˆľ‚˘‹K–ń‚Ě‚˘‚¸‚ę‚É‚¨‚˘‚Ä‚ŕT1i”S–ŒŠŕj‚͗ǍD‚Č—\Œă‚đ‚ŕ‚‚ą‚Ć‚Ş”F‚ß‚ç‚ę‚Ä‚˘‚éB‚‚˘‚ĹT2iss Šŕj‚Ş5 ”Nś‘ś—Ś40`60“‚Ć”äŠr“I—ǍD‚ȐŹŃ‚đŽŚ‚ˇBT1, 2 ‚É”äŠr‚ľ‚ÄT3, 4 ‚Ě—\Œă‚ވŤ‚˘‚ą‚Ć‚Í–{–MA‰˘•Ä‚Ć‚ŕ‚É‘˝‚­‚Ě•ń‚Ş‚ ‚čƒRƒ“ƒZƒ“ƒTƒX‚Ş“ž‚ç‚ę‚Ä‚˘‚éBT ˆöŽq‹K’股‚é‘ź‚ĚˆöŽq‚Ć‚ľ‚āAŠĚZ8jA‘ź‘ŸŠíiˆÝA\“ńŽw’°AŒ‹’°AäXA‘ĺ–ԁAŠĚŠO’_ŠÇjZA–ĺ–ŹAŠĚ“Ž–ŹZ‚Ş‹“‚°‚ç‚ę‚éB–{–M‚Ĺ‚ÍŠĚ\“ńŽw’°ŠÔ–ŒZ‚ޏd—v‚Č—\ŒăˆöŽq‚Ĺ‚ ‚é‚ą‚Ć‚Ş•ń‚ł‚ę‚Ä‚Ť‚˝BŠĚ—tŘœ‚âäX“ޏ\“ńŽw’°Řœ‚đŽ{s‚ľ‚Ä‚ŕ—\Œă•s—Ç‚Č‚¤‚ŚŽčpŠÖ˜AŽ€–S—Ś‚ލ‚‚˘‚ą‚Ć‚ŕ’m‚ç‚ę‚Ä‚˘‚é9, 10jB‚ť‚Ě‘źAŽîᇕމť“x2, 8, 11jAƒŠƒ“ƒpŠÇZ12jA_ŒoŽüˆÍZ13jAss Z‹——Ł14jA’_”X°‹ß–T‚ĚŠĚŽŔŽż“ŕ‚Ě”÷Ź“]ˆÚ15, 16j‚Č‚Ç‚ŕ—\ŒăˆöŽq‚Ć‚ľ‚Ä•ń‚ł‚ę‚Ä‚˘‚éB

N ˆöŽq‚ˇ‚Č‚í‚żƒŠƒ“ƒpß“]ˆÚ‚Ş—\ŒăˆöŽq‚Ĺ‚ ‚é‚Ć‚˘‚¤•ń‚Í”ńí‚É‘˝‚˘B‚ą‚Ć‚É‘ĺ“Ž–ŹŽüˆÍƒŠƒ“ƒpß“]ˆÚ—zŤ‚Í—\Œă•s—Ç‚Ĺ‚ ‚é17, 18jB

ăq‚ľ‚˝‚悤‚ČŽîᇈöŽq‚đ‘g‚ݍ‡‚í‚š‚Ä‘‡“I‚É—\Œă‚𐄒股‚鎎‚Ý‚ŕ‚¨‚ą‚Č‚í‚ę‚Ä‚˘‚é19jB

ŽĄ—ĂˆöŽq‚Ě‘ă•\“I‚Č‚ŕ‚Ě‚ŞŘœ’f’[Šŕ—zŤiR1 Řœj‚Ĺ‚ ‚éB’_”XŠŕ‚̐i“W—lŽŽ‚Í‘˝—l‚Č‚˝‚ß‘Oq‚ľ‚˝‘˝‚­‚̐i“WˆöŽq‚ɉž‚ś‚ÄR0Žčp‚đs‚Č‚¤‚ą‚Ć‚Şd—v‚Ĺ‚ ‚éB

ŽQl•śŒŁ

1j Kayahara M, Nagakawa T, Nakagawara H, Kitagawa H, Ohta T. Prognostic factors for gallbladder cancer in Japan.Ann Surg. 2008 Nov; 248: 807-14.

2j Choi SB, Han HJ, Kim CY, Kim WB, Song TJ, Suh SO, Kim YC, Choi SY. Surgical outcomes and prognostic factors for T2 gallbladder cancer following surgical resection. J Gastrointest Surg. 2010 Apr; 14: 668-78. Epub 2009 Dec 22.

3j Regimbeau JM, Fuks D, Bachellier P et al. Prognostic value of jaundice in patients with gallbladder cancer by the AFC-GBC-2009 study group. EJSO 2011; 37: 505-512.

4j Han HS, Cho JY, Yoon YS, Ahn KS, Kim H. Preoperative inflammation is a prognostic factor for gallbladder carcinoma. Br J Surg 2011; 98: 111-116.

5j Varga M, Obrist P, Schneeberger S, Mühlmann G, Felgel-Farnholz C, Fong D, Zitt M, Brunhuber T, Schäfer G, Gastl G, Spizzo G.Overexpression of epithelial cell adhesion molecule antigen in gallbladder carcinoma is an independent marker for poor survival. Clin Cancer Res. 2004 May 1; 10: 3131-6.

6j Shibata K, Uchida H, Iwaki K, Kai S, Ohta M, Kitano S.Lymphatic invasion: an important prognostic factor for stages T1b-T3 gallbladder cancer and an indication for additional radical resection of incidental gallbladder cancer. World J Surg. 2009 May; 33: 1035-41.

7j Butte JM, Matsuo K, Gonen M, et al. Gallbladder cancer: Differences in presentation, surgical treatment, and survival in patients treated at centers in three countries. Am Col Surg 2011; 212: 50-61.

8j Ito H, Ito K, D'Angelica M, Gonen M, Klimstra D, Allen P, DeMatteo RP, Fong Y, Blumgart LH, Jarnagin WR.Accurate staging for gallbladder cancer: implications for surgical therapy and pathological assessment. Ann Surg. 2011 Aug; 254: 320-5.

9j Araida T, Yoshikawa T, Azuma T, Ota T, Takasaki K, Hanyu F.Indications for pancreatoduodenectomy in patients undergoing lymphadenectomy for advanced gallbladder carcinoma. J Hepatobiliary Pancreat Surg. 2004; 11: 45-9.

10j Shimizu H, Kimura F, Yoshidome H, Ohtsuka M, Kato A, Yoshitomi H, Nozawa S, Furukawa K, Mitsuhashi N, Takeuchi D, Suda K, Yoshioka I, Miyazaki M.Aggressive surgical approach for stage IV gallbladder carcinoma based on Japanese Society of Biliary Surgery classification. J Hepatobiliary Pancreat Surg. 2007; 14: 358-65. Epub 2007 Jul 30.

11j Negi SS, Singh A, Chaudhary A. Lymph Nodal Involvement as Prognostic Factor in Gallbladder Cancer: Location, Count or Ratio? J Gastrointest Surg 15: 1017-1025.

12j Shibata K, Uchida H, Iwaki K, Kai S, Ohta M, Kitano S. Lymphatic invasion: An important prognostic factor for Stages T1b-T3 gallbladder cancer and an indication for additional radical resection of incidental gallbladder cancer. World J Surg 2009: 33;: 1035-1041.

13j Yamaguchi R, Nagino M, Oda K, Kamiya J, Uesaka K, Nimura Y. Perineural invasion has a negative impact on survival of patients with gallbladder carcinoma. Br J Surg. 2002 Sep; 89: 1130-6.

14j Wakai T, Shirai Y, Yokoyama N, Ajioka Y, Watanabe H, Hatakeyama K. Depth of subserosal invasion predicts long-term survival after resection in patients with T2 gallbladder carcinoma. Ann Surg Oncol. 2003 May; 10: 447-54.

15j Ohtsuka M, Miyazaki M, Itoh H, et al. Route of hepatic metastasis of gallbladder carcinoma. Anat Pathol 1998; 109: 62-68.

16j Endo I, Shimada H, Takimoto A, Fujii Y, Miura Y, Sugita M, Morioka D, Masunari H, Tanaka K, Sekido H, Togo S.Microscopic liver metastasis: prognostic factor for patients with pT2 gallbladder carcinoma. World J Surg. 2004 Jul; 28: 692-6.

17j Shimada H, Endo I, Togo S, Nakano A, Izumi T, Nakagawara G. The role of lymph node dissection in the treatment of gallbladder carcinoma. Cancer. 1997 Mar 1; 79: 892-9.

18j Kondo S, Nimura Y, Hayakawa N, Kamiya J, Nagino M, Uesaka K. Regional and para-aortic lymphadenectomy in radical surgery for advanced gallbladder carcinoma. Br J Surg. 2000 Apr; 87: 418-22.

19j Miura F, Asano T, Amano H, Toyota N, Wada K, Kato K, Takada T, Takami H, Ohira G, Matsubara H. New prognostic factor influencing long-term survival of patients with advanced gallbladder carcinoma. Surgery. 2010 Aug; 148: 271-7. Epub 2010 Jun 8.


ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ31
\“ńŽw’°“ű“Ş•”Šŕ‚ɑ΂ľ‚ċǏŠ“I“ű“Ş•”ŘœpiŠO‰Č“IC“ŕŽ‹‹ž“Ij‚͐„§‚ł‚ę‚é‚Š?

\“ńŽw’°“ű“Ş•”Šŕ‚ɑ΂ľ‚Ä‚ÍäX“ޏ\“ńŽw’°Řœp‚Ş•W€“IŽĄ—Ă‚Ĺ‚ ‚čA‹ÇŠ“I“ű“Ş•”ŘœpiŠO‰Č“IC“ŕŽ‹‹ž“Ij‚͐„§‚ł‚ę‚Č‚˘B

„§“x1@ƒGƒrƒfƒ“ƒXƒŒƒxƒ‹C

‰đŕ

“ű“Ş•”Šŕ‚ɑ΂ˇ‚éÚ×‚Č•a—‘gDŠw“IŒŸ“˘‚Š‚çAoddi ‹Ř‚đ‰z‚Ś‚Č‚˘“ű“Ş•”Šŕ‚Ĺ‚ÍƒŠƒ“ƒpß“]ˆÚ‚đ‹N‚ą‚ˇ‰Â”\Ť‚Ş‹É‚ß‚Ä’á‚˘‚Ş‚ą‚Ć‚Ş‚í‚Š‚č1-3jA‹ß”N—lX‚Č“ű“Ş•”Řœ‚ ‚邢‚Í“ŕŽ‹‹ž“IŘœp‚Ć‚˘‚Á‚˝‹ÇŠŘœ‚ம‚Ý‚ç‚ę‚é‚悤‚É‚Č‚č4, 5jA‘Šú“ű“Ş•”Šŕ‚ɑ΂ľ‚ďkŹŽčp‚ŕ‘I‘đ‰Â”\‚Ć‚Ě•ń‚Ş‘‚Ś‚Ä‚Ť‚˝Bˆę•ű‚ŁA“ű“Ş•”Šŕ‚ɑ΂ľ‹ÇŠŘœ‚đs‚Á‚˝‚Ć‚ą‚덂—Ś‚ɍĔ­‚ľ‚˝‚Ć‚Ě•ń6j‚âA“ű“Ş•”Řœ‚ō‚—Ś‚ÉŠŕˆâŽc‚đ”F‚ß‚˝‚Ć‚Ě•ń7, 8j‚ŕ‚ ‚éB

‘BŽî‚ɑ΂ˇ‚ékŹŽčp‚Í—LŒř‚ČŠO‰ČŽĄ—Ă‚Ć‚ľ‚Ä‚ĚƒRƒ“ƒZƒ“ƒTƒX‚Í‚Ů‚Ú“ž‚ç‚ę‚Ä‚˘‚é‚ƍl‚Ś‚ç‚ę‚é‚Ş9jA‘Šú“ű“Ş•”Šŕ‚ɑ΂ˇ‚é“ű“Ş•”Řœp‚Ě—LŒřŤ‚đŽŚ‚ˇƒGƒrƒfƒ“ƒX‚É–R‚ľ‚­A•W€“I‚ČŽĄ—Ă‚Ć‚ľ‚Ä‚ÍŠm—§‚ľ‚Ä‚˘‚Č‚˘B

‚Ü‚˝A “ŕŽ‹‹ž“I“ű“ŞŘœp‚ŕAäX“ޏ\“ńŽw’°Řœ—á10jAŠO‰Č“I“ű“ŞŘœ—á‚ĚŒŸ“˘11j‚Š‚ç‘BŽî“ŕŠŕA”S–Œ“ŕŠŕ‚É‚Ü‚Ĺ“K‰žŠg‘ĺ‚̉”\Ť‚đq‚ׂé•ń‚Ş‚ ‚éB‚ľ‚Š‚ľA˜_‹’‚Ć‚Č‚éÇ—ᐔ‚ÍŒŔ‚ç ‚ę‚Ä‚¨‚čA•W€ŽĄ—Ă‚Ć‚ˇ‚é‚É‚Í‚ł‚ç‚Č‚éƒf[ƒ^‚Ě’~Ď‚É‚ć‚č“K‰ž‚đŠm—§‚ľ‚Ä‚˘‚­‚ą‚Ć‚Ş‹‚ß‚ç‚ę‚éB

ˆę•űAŠŕ‚Ş‚˘‚Á‚˝‚ńoddi ‹Ř‚É’B‚ˇ‚é‚ĆƒŠƒ“ƒpß“]ˆÚ—Ś‚͍‚‚­‚Č‚é9, 12jBŒťÝA‘gDi’B“xf’f‚É‚¨‚˘‚Ä‚ÍEUS ‚ĆIDUS ‚Ş—L—p‚Ć‚ł‚ę‚Ä‚˘‚é‚ŞAoddi ‹Ř‚Ö‚ĚŠŕZ‚̐łf—Ś‚ލ‚‚˘‚Ć‚Í‚˘‚Ś‚Č‚˘13-15jB‚ą‚Ě‚˝‚ߌťs‚Ěmodality ‚Ĺ‚Íoddi ‹Ř‚Ö‚ĚŠŕZ‚Ě”ť’č‚Í•s‰Â”\‚ĆŒž‚í‚´‚é‚đ“ž‚¸AT1 “ű“Ş•”Šŕ‚ɑ΂ľ‚Ă͋ǏŠŘœ‚ž‚Ż‚Ĺ‚ÍŒŔŠE‚Ş‚ ‚é‚ĆŽv‚í‚ę‚éB

‚ć‚Á‚ďp‘Of’f‚ލ˘“ď‚ČŒť’iŠK‚ł́A“ű“Ş•”Šŕ‚ɑ΂ˇ‚é‹ÇŠ“I“ű“Ş•”ŘœiŠO‰Č“IC“ŕŽ‹‹ž“Ij‚ĚƒRƒ“ƒZƒ“ƒTƒX‚Í“ž‚ç‚ę‚Ä‚¨‚炸AäX“ޏ\“ńŽw’°ŘœpiPD ‚ ‚邢‚ÍPPPDj‚Ş•W€pŽŽ‚ƍl‚Ś‚ç‚ę‚éBĄŒă‚͐łŠm‚ȏp‘Of’f‚Ć’ˇŠúŹŃ‚ĚƒGƒrƒfƒ“ƒX‚ĚŠm—§A‚ť‚ę‚ÉŠî‚Ă‚˘‚˝‘OŒü‚Ť‚Ě—Ő°ŽŽŒą‚Ş•K—v‚Ĺ‚ ‚éB

ŽQl•śŒŁ

1j Vˆä“c’B—Y: \“ńŽw’°“ű“Ş•”Šŕ‚Ě—Ő°•a—Šw“IŒ¤‹†@|—\Œă‹K’čˆöŽq‚ĆÄ”­—lŽŽ‚ɂ‚˘‚ā|. “úÁŠO‰ďŽ@1989; 22: 2009-2017.

2j ’†”öşŒöAŒ´“c–žśA–ě˜Q•q–žAŠÝ–{Žá•FA’|“cLA•ě„A‘ź. : \“ńŽw’°“ű“Ş•”Šŕ‚ĚŠO‰ČŽĄ—ÐŹŃ‚Ć–â‘č“_. “úŠO‰ďŽ@1992; 93: 805-810.

3j ’ˇ’rKŽ÷AçXŠâˆę’jA‘ĺ“ŕ“cŽŸ˜YA‘ź. : \“ńŽw’°“ű“Ş•”ŠŕŘœ—á‚Ě—Ő°•a—Šw“IŒŸ“˘. ’_“š2009: 23: 74-79.

4j Han J, Kim MH.; Endoscopic papillectomy for adenomas of the major duodenal papilla (with video). Gastrointest Endosc 2006; 63: 292-301.

5j Bohnacker S, Soehendra N, Maguchi H, Chaung JB, Howell DA.: Endoscopic resection of benign tumors of the papilla of vater. Endoscopy 2006; 38: 521-525.

6j Branum GD, Pappas TN, Meyers WC.: The management of tumors of the ampulla of Vater by local resection. Ann Surg 1996; 224: 621-627.

7j –؉şšć•śAÂ–öŹ–žA•Ÿ“cGˆę: ‘Šú\“ńŽw’°“ű“Ş•”Šŕi“ű“Ş•”Šŕj‚ĚŽĄ—Ă•űj. “úŠO‰ČŒn˜A‰ďŽ@2001; 26: 1130-1134.

8j –؉şšć•śAŒ´‰ë—YAŽ™‹ĘFmAÂ–öŹ–žA”’…˜a—Y: Œo\“ńŽw’°“I“ű“ŞŘœ. ’_‚ĆäX@2003; 24: 27-31.

9j Roggin KK, Yeh JJ, Ferrone CR, Riedel E, Gerders H, Klimstra DS, et al.: Limitations of Ampulledtomy in the Treatment of Nonfamilial Ampulllary Neoplasms. Annals of Surgical Oncology 2005; 12, 971-980.

10j Ito K, Fujita N, Noda Y, Kobayashi G, Obana T, Horaguchi J, et al. Impact of technical modification of endoscopic papillectomy for ampullary neoplasm on the occurrence of complications. Dig Endosc 2012; 24: 30-35.

11j Klein P, Reingruber B, Kastl S, Dworak O, Hohenberger W.: Is local excision of pT1-ampullary carcinomas justified?. Eur J Surg Oncol 1996; 22: 366-371.

12j Yoon, YS, Kim SW, Park SJ, Lee HS, Jang JY, Choi MG, et al.: Clinicopathologic analysis of early ampullary cancers with a focus on the feasibility of ampullectomy. Anals of Surgery 2005; 242. 92-100.

13j ‚‹´–MKA^ŒűG‰îAŠƒŔ˜NśAź‰i—˛—TAŹŽR“ŕŠwAÎ“n—TrA‘ź: EUS/IDUS ‚É‚ć‚é“ű“Ş•”Šŕ‚̐i“W“xf’f. ’_‚ĆäX@2004; 25: 475-479.

14j ‘ĺ‹v•Ű—T’źA{ŽRł•śAŒEě—ÇœAA›ÁmแA“cŠ—msA‰zě‹ĎA‘ź: \“ńŽw’°“ű“Ş•”Šŕ‚̐f’f|‰ć‘œf’f‚̑Δä‚Ć•]‰ż|. ’_‚ĆäX@2003; 24: 3-8.

15j ˆÉ“ĄŒ[A“Ą“c’źFA–ě“c—TAŹ—э„A–Ř‘şŽ–¤: ’´‰š”g“ŕŽ‹‹ž‚É‚ć‚é“ű“Ş•”Šŕ‚̐i’B“xf’f. ’_‚ĆäX@2003; 24: 9-13.


ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ32
“ű“Ş•”ŠŕŘœŒă‚Ě—\ŒăˆöŽq‚ɂ͂ǂ̂悤‚Č‚ŕ‚Ě‚Ş‚ ‚é‚Š?

ƒŠƒ“ƒpß“]ˆÚ‚Ě—L–łAäXZ‚Ě—L–łA_ŒoZ‚Ě—L–ł‚Č‚Ç‚Ş‚ ‚°‚ç‚ę‚éB

„§“x‚Č‚ľ@ƒGƒrƒfƒ“ƒXƒŒƒxƒ‹C

‰đŕ

“ű“Ş•”Šŕ‚Í’_EäX—Ěˆć‚É‚¨‚Ż‚éˆŤŤŽîᇂ̒†‚Ĺ‚Í”äŠr“I—\Œă—ǍD‚ČŠŕŽî‚Ĺ‚Í‚ ‚é‚ŞAŽîᇂ̐i“W“x‚É‚ć‚č—\Œă‚Í’˜‚ľ‚­ˆŮ‚Č‚čAStage Ⅳ ‚Ĺ‚Í0-19%‚Ć‚T”Nś‘ś‚ŕŒľ‚ľ‚­‚Č‚é1-3jB

“ű“Ş•”Šŕ‚̐i“WˆöŽq‚Ć—\Œă‚Ć‚ĚŠÖ˜A‚É‚¨‚˘‚ăŠƒ“ƒpß“]ˆÚ—zŤ—á‚Í—LˆÓ‚É—\Œă•s—Ç‚Ĺ‚ ‚čAƒŠƒ“ƒpß“]ˆÚ‚Ě—L–ł‚Í—\Œă‚É‘ĺ‚Ť‚­‰e‹ż‚ˇ‚é‚ƍl‚Ś‚ç‚ę‚é4-8jB

äXZ—zŤ—á‚͉AŤ—á‚É”ä‚ׂė\Œă•s—Ç‚Ĺ‚ ‚č3, 9, 10jAŠŕ‚Ş‚˘‚Á‚˝‚ńäXŽŔŽż‚É‚¨‚ć‚Ô‚ĆäXŠŕ‚Ć“Ż—l‚̐ś•¨Šw“IˆŤŤ“x‚đ—L‚ˇ‚é—l‚É‚Č‚é‚˝‚߁AäXZ‚Í—\Œă‚ɉe‹ż‚đ‹y‚Ú‚ˇd—v‚Ȑi“W“xˆöŽq‚ƍl‚Ś‚ç‚ę‚éB

–ŹŠÇZ‚̓Šƒ“ƒpŠÇZAĂ–ŹZ‚Č‚ÇŠŕ‚̐öÝŤ‚̐i“W“x‚đ—\‘Ş‚ł‚š‚é‚ŕ‚̂ŁA‚˘‚Á‚˝‚ńŠŕ‚Ş–ŹŠÇ‚ɐZ‚ˇ‚é‚Ć“]ˆÚEÄ”­ˆöŽq‚Ć‚Č‚čA—zŤ—á‚Ĺ‚Í—LˆÓ‚É—\Œă•s—Ç‚Ć‚Č‚é6, 11, 12jB‚Ü‚˝_ŒoZ‚ŕd—v‚Č—\ŒăˆöŽq‚Ć‚ˇ‚é•ń7, 13j‚âAƒŠƒ“ƒpß“]ˆÚ‚Ć‹­‚­‘ŠŠÖ‚ˇ‚é“÷Šá“IŒ`‘Ô‚đd—v‚Č—\ŒăiÄ”­jˆöŽq‚Ć‚ˇ‚é•ń5, 14j‚ŕ‚ ‚éB‚ł‚ç‚ɍזEŒ`Žż‚É‚ć‚鈟•Ş—Ţ‚Ĺpancreatobiliary type ‚Í intestinal type ‚ć‚č—\Œă•s—Ç‚Ć‚ˇ‚é•ń‚ŕ‚ ‚éB

‚‚܂čA‚ą‚ę‚ç“ű“Ş•”Šŕ‚̐i“WŒ`ŽŽ‚đÚ×‚ÉŒŸ“˘‚ˇ‚é‚ą‚Ć‚É‚ć‚čÄ”­‚ƒŠƒXƒNŒQ‚Ě—\‘ނމ”\‚Ć‚Č‚čAƒŠƒXƒN‚̍‚‚˘Ç—á‚É‚¨‚˘‚Ă͏pŒă‚ĚŒľd‚ČƒtƒHƒ[ƒAƒbƒv‚Ş•K—v‚Ć‚ł‚ę‚éB

ŽQl•śŒŁ

1j Nagakawa T, Kayahara M, Ikeda S, Futakawa S, Kakita A, Kawarada H, et al.; Biliary tract cancer treatment: results from the Biliary Tract Cancer Stastistics Resgistry in Japan. J Hepatobiliary Pancreat Surg 2002; 9: 569-575.

2j Beger HG, Treischke F, Gansauge F, Harada N, Hiki N, Mattfeldt T.; Tumor of the ampulla of Vater: experience with local or radical resection in 171 consecutively treated patients. Arch Surg 1999; 134: 526-532.

3j –؉şšć•śAŒ´‰ë—YAŽ™‹ĘFmAÂ–öŹ–žA”’…˜a—Y.; Vater “ű“Ş•”Šŕ‚̐i“W—lŽŽ‚Ć—\Œă. Á‰ťŠíŠO‰Č 2002; 25: 1797-1804.

4j Shirai Y, Ohtani T, Tsukada K, Hatakeyama K.; Patterns of lymphatic spread of carcinoma of the ampulla of Vater. Br J Surg 1997; 84: 1012-1016.

5j Kayahara M, Nagakawa T, Ohta T, Kitagawa H, Miyazaki I.; Surgical strategy for carcinoma of the papilla of Vater based on the lymphatic spread and mode of recurrence. Surgery 1997; 121: 611-617.

6j Mizuno T, Ishizuki Y, Ogura K, Yoshimoto J, Kawasaki S.; Clinical significance of immunohistochemically detectable lymph node metastasis in adenocarcinoma of the ampulla of Vater. Br J Surg 2006; 93: 221-225.

7j Chan C, Herrera MF, de la Garza L, Quintanilla-Martinez L, Vargas-Vorackova F, Richaud-Patin Y, et al.; Clinical Behavior and prognsostic factors of periampullary adenocarcinoma. Ann Surg 1995; 222: 632-637.

8j Hornick J, Johnston F, Hawkins G, et al. A single-institution review of 157 patients presenting with benign and malignant tumors of the ampulla of Vater: Management and outcomes. Sugery 2011; 150: 169-176.

9j Vˆä“c’B—Y: \“ńŽw’°“ű“Ş•”Šŕ‚Ě—Ő°•a—Šw“IŒ¤‹†; —\Œă‹K’čˆöŽq‚ĆÄ”­Œ`ŽŽ‚ɂ‚˘‚Ä. “úÁŠO‰ďŽ 1989; 22: 2009-2017.

10j Chan C, Herrera MF, de la Garza L, Quintanilla-Martinez L, Vargas-Vorackova F, Richaud-Patin Y, et al.; Clinical Behavior and prognsostic factors of periampullary adenocarcinoma. Ann Surg 1995; 222: 632-637.

11j Hasddad L, Patzina R, Jukemura J. Lymph Node Involvement and Not the Histopathologic Subtype Is Correlated with Outcome After resection of Adenocarcinoma of the Ampulla of Vater. J Gastrointestinal Surg 2010; 14: 719-728.

12j Îě”ŽlA–؉şšć•śAˆŔ‰išŽjA”’…˜a—Y \“ńŽw’°“ű“Ş•”Šŕ‚ɑ΂ˇ‚éäX“ޏ\“ńŽw’°Řœ‚Ě’ˇŠúŹŃ‚Ć—\ŒăˆöŽq. ’_‚ĆäX 2012; 33: 267-270.

13j Hatzaras I, George N, Bloomston M. et al. Predictors of Survival in Periampullary Cancers Following Pancreaticoduodenectomy. Ann Surg Oncol 2010; 17: 991-997.

14j Kayahara M, Nagakawa T, Ohta T, Kitagawa H, Miyazaki I.; Surgical strategy for carcinoma of the papilla of Vater based on the lymphatic spread and mode of recurrence. Surgery 1997; 121: 611-617.


ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ33
’_ŠÇŠŕ‚Ě’_ŠÇŘ—Ł’f’[‚ɑ΂ˇ‚ép’†•a—f’f‚͍s‚¤‚ׂŤ‚ŠH

’_ŠÇŠŕ‚Ĺ‚Í’_ŠÇŘ—Ł’f’[‚Ĺ‚ĚŠŕˆâŽc‚Ě—L–ł‚Ş—\Œă‚É‘ĺ‚Ť‚­‰e‹ż‚đ‹y‚Ú‚ˇˆöŽq‚Ĺ‚ ‚é‚˝‚߁C’_ŠÇŘ—Ł’f’[‚É‚¨‚Ż‚ép’†•a—f’f‚đs‚¤‚ą‚Ć‚đ„§‚ˇ‚éB

„§“x1@ƒGƒrƒfƒ“ƒXƒŒƒxƒ‹B

‰đŕ

’_ŠÇŠŕ‚Ě‹ÇŠi“W—lŽŽ‚ĚŒŸ“˘‚ł́CZŠŕ‚É‚ć‚é’ˇŽ˛•űŒü‚Ö‚Ě•Ç“ŕi“W‚Í“÷Šá“IŽîᇉ‚Š‚ç10mm –˘–ž‚É—Ż‚Ü‚é‚ŞCă”ç“ŕŠŕ‚É‚ć‚é•\‘wŠg‘ĺi“W‚Í20mm ˆČă‚É‹y‚Ô‚ą‚Ć‚ŕ‹H‚Ĺ‚Í‚Č‚˘1jB•\‘wŠg‘ĺi“W‚Í“÷ŠáŒ`‘Ô‚Ş“ű“ŞŒ^‚Ü‚˝‚Í–c’ŁŒ^‚ĚŽîᇂɐ”ş‚ˇ‚é‚ą‚Ć‚Ş‘˝‚­C‘gDŒ^‚Ĺ‚Í“ű“Ş‘BŠŕ‚ɍ‚—Ś‚ɐ”ş‚ˇ‚é1-3jB

’_ŠÇŠŕ‚ł́CŘœ’f’[‚¨‚ć‚Ń”—Ł–Ę‚Ĺ‚ĚŠŕˆâŽc‚Ě—L–ł‚Ş—\Œă‚ÉĹ‚ŕ‘ĺ‚Ť‚­‰e‹ż‚đ‹y‚Ú‚ˇˆöŽq‚Ĺ‚ ‚é3-8jB“Á‚ɁC’_ŠÇŘ—Ł’f’[‚ÉŠŕˆâŽc‚đ”F‚ß‚Č‚˘Žčp‚đ‹s‚ˇ‚é‚ą‚Ć‚Ěd—vŤ‚Ş‘˝”‚Ě˜_•ś‚ŏq‚ׂç‚ę‚Ä‚˘‚é3-8jB’_ŠÇŘ—Ł’f’[‚Ĺ‚ĚŠŕ—zŤ‚ɂ́CgZŠŕ—zŤh‚Ɓgă”ç“ŕŠŕ—zŤh‚Ć‚Ş‚ ‚čCZŠŕ—zŤ—á‚̏pŒăŹŃ‚Í‹É‚ß‚Ä•s—Ç‚Ĺ‚ ‚é‚ŞCă”ç“ŕŠŕ—zŤ—á‚̏pŒăŹŃ‚͔ӊú‹ÇŠÄ”­‚ĚƒŠƒXƒN‚Í‚ ‚é‚ŕ‚Ě‚Ě”äŠr“I—ǍD‚Ĺ‚ ‚é‚ą‚Ć‚Ş•ń‚ł‚ę‚Ä‚˘‚é3-8jB‚ľ‚˝‚Ş‚Á‚āCp’†‚̐v‘Ź‘gDf’f‚Ĺ’_ŠÇŘ—Ł’f’[‚ŞŠŕ—zŤ‚Ĺ‚ ‚Á‚˝ę‡‚ɂ́CZŠŕ‚Ĺ‚ ‚é‚Ě‚Šă”ç“ŕŠŕ‚Ĺ‚ ‚é‚Ě‚Š‚đŠÓ•Ę‚ˇ‚é‚ą‚Ć‚Şd—v‚Ĺ‚ ‚éB

p’†v‘Ź‘gDf’f‚É‚ć‚é’_ŠÇŘ—Ł’f’[‚Ě•]‰ż‚́CŠŕˆâŽc‚đ”đ‚Ż‚é‚˝‚߂ɏd—v‚ČŒŸ¸‚Ĺ‚ ‚é9-11jB‚ľ‚Š‚ľA’_ŠÇŘ—Ł’f’[‚ސZŠŕ—zŤ‚Ěę‡‚ɒljÁŘœ‚ˇ‚é‚ą‚Ć‚Ĺ—\Œă‚މü‘P‚ˇ‚é‚Š”Ű‚Š‚ÉŠÖ‚ľ‚ẮC‘ÎŰ‚Ć‚Č‚éÇ—ᐔ‚ޏ­‚Č‚­“ˆę‚ľ‚˝ŒŠ‰đ‚Í“ž‚ç‚ę‚Ä‚˘‚Č‚˘12-14jB

ŽQl•śŒŁ

1j Ebata T, Watanabe H, Ajioka Y, Oda K, Nimura Y. Pathological appraisal of lines of resection for bile duct carcinoma. Br J Surg 2002; 89: 1260-1267.

2j Sakamoto E, Nimura Y, Hayakawa N, Kamiya J, Kondo S, Nagino M, et al. The pattern of infiltration at the proximal border of hilar bile duct carcinoma: a histologic analysis of 62 resected cases. Ann Surg 1998; 227: 405-411.

3j Igami T, Nagino M, Oda K, Nishio H, Ebata T, Yokoyama Y, et al. Clinicopathologic study of cholangiocarcinoma with superficial spread. Ann Surg 2009; 249: 296-302.

4j Wakai T, Shirai Y, Moroda T, Yokoyama N, Hatakeyama K. Impact of ductal resection margin status on long-term survival in patients undergoing resection for extrahepatic cholangiocarcinoma. Cancer 2005; 103: 1210-1216.

5j Sasaki R, Takeda Y, Funato O, Nitta H, Kawamura H, Uesugi N, et al. Significance of ductal margin status in patients undergoing surgical resection for extrahepatic cholangiocarcinoma. World J Surg 2007; 31: 1788-1796.

6j Ojima H, Kanai Y, Iwasaki M, Hiraoka N, Shimada K, Sano T, et al. Intraductal carcinoma component as a favorable prognostic factor in biliary tract carcinoma. Cancer Sci 2009; 100: 62-70.

7j Nakanishi Y, Kondo S, Zen Y, Yonemori A, Kubota K, Kawakami H, et al. Impact of residual in situ carcinoma on postoperative survival in 125 patients with extrahepatic bile duct carcinoma. J Hepatobiliary Pancreat Sci 2010; 17: 166-173.

8j Higuchi R, Ota T, Araida T, Kobayashi M, Furukawa T, Yamamoto M. Prognostic relevance of ductal margins in operative resection of bile duct cancer. Surgery 2010; 148: 7-14.

9j ´…NmA‘ĺ’ˏŤ”VAˆÉ“Ą@”ŽA–Ř‘ş•ś•vA´…G–žAˆŔ•f@‘A‘ź. ŠĚ–ĺ•”’_ŠÇŠŕŘœÇ—á‚É‚¨‚Ż‚ép’†v‘Ź•a—f’f‚É‚ć‚é’_ŠÇ\“ńŽw’°‘¤’f’[•]‰ż‚Ě—L—pŤ. ’_“š 2004; 18: 182-188.

10j ”ö“‡‰p’mA“‡“c˜a–žA•˝‰ŞL‰îAâ–{—ǍOA]č@–ŤAŹ›’q’jA‘ź. ŠĚ–ĺ•”’_ŠÇŠŕ‚̐i“W—lŽŽ‚ĆŠĚ‘Ÿ‘¤Řœ’f’[‚Ě—Ő°•a—Šw“I“Á’ĽDÁ‰ťŠíŠO‰Č 2007; 30: 619-627.

11j ]č@–ŤA“‡“c˜a–žAŠÝ@—f“ńA“ޗǁ@‘AŹ›’q’jD’_ŠÇŠŕŠO‰ČŘœŽž‚Ě’_ŠÇ’f’[p’†v‘Ź‘gDf’f‚ĚˆÓ‹`. ŠĚ’_äX 2011; 62: 1079-1084.

12j Shingu Y, Ebata T, Nishio H, Igami T, Shimoyama Y, Nagino M. Clinical value of additional resection of a margin-positive proximal bile duct in hilar cholangiocarcinoma. Surgery 2010; 147: 49-56.

13j Konishi M, Iwasaki M, Ochiai A, Hasebe T, Ojima H, Yanagisawa A. Clinical impact of intraoperative histological examination of the ductal resection margin in extrahepatic cholangiocarcinoma. Br J Surg 2010; 97: 1363-1368.

14j Ribero D, Amisano M, Lo Tesoriere R, Rosso S, Ferrero A, Capussotti L. Additional resection of an intraoperative margin-positive proximal bile duct improves survival in patients with hilar cholangiocarcinoma. Ann Surg 2011; 254: 776-781.


ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ34
ŠĚ\“ńŽw’°ŠÔ–Œ‚É’źÚZ‚Ě‚Č‚˘’_”XŠŕ‚É—\–h“IŠĚŠO’_ŠÇŘœ‚Ě•K—v‚Í‚ ‚é‚ŠH

ŠĚ\“ńŽw’°ŠÔ–Œ‚ɐZ‚Ş”F‚ß‚ç‚ę‚Č‚˘is’_”XŠŕ‚ɑ΂ľ‚Ä—\–h“I‚Č’_ŠÇŘœ‚Ş—\Œă‚đ‰ü‘P‚ł‚š‚é‚Ć‚˘‚¤Ř‹’‚Í‚Č‚˘B‚ľ‚Š‚ľ‚Č‚Ş‚çŠĚ\“ńŽw’°ŠÔ–Œ‚ɋߐڂľ‚˝’_”Xčň•”‚̐is’_”XŠŕAƒŠƒ“ƒpß“]ˆÚ‚Ě‹^‚í‚ę‚éÇ—á‚Ĺ‚ÍŠĚŠO’_ŠÇŘœ‚đ•t‰Á‚ˇ‚é‚ą‚Ć‚É‚ć‚荪ŽĄŤ‚đ‚‚ß‚é‰Â”\Ť‚đ”Ű’č‚Ĺ‚Ť‚Č‚˘B

„§“x2@ƒGƒrƒfƒ“ƒXƒŒƒxƒ‹C

‰đŕ

p‘O‰ć‘œf’f‚âp’†ŠŒŠ‚Š‚ç–ž‚ç‚Š‚ɩ̏\“ńŽw’°ŠÔ–Œ‚ɐZ‚Ě”F‚ß‚ç‚ę‚Č‚˘is’_”XŠŕ‚ɁAƒŠƒ“ƒpßŠs´‚đŠmŽŔ‚ɍs‚¤‚˝‚ß‚Ě‡•šŘœ‚âöÝ“I‚Č•a—‘gDŠw“IŠŕZ‚đ”O“Ş‚É‚¨‚˘‚˝—\–h“I’_ŠÇŘœ‚Ě—L—pŤ‚đŘ–ž‚ˇ‚é•ń‚Í‚Č‚­A‘ĺ‹K–Í‚Č‘˝Ž{Ý‹¤“ŻŒă‚ëŒü‚ŤŒ¤‹†‚Ĺ‚ŕA’_ŠÇZ‚Ě”F‚ß‚ç‚ę‚Č‚˘is’_”XŠŕ‚đŠĚŠO’_ŠÇŘœ•Ę‚É—\Œă‚đŒŸ“˘‚ľ‚Ä‚ŕ“ŒvŠw“I‚É—LˆÓˇ‚đ”F‚ß‚ç‚ę‚Č‚˘‚˝‚߁A—\–h“I’_ŠÇŘœ‚Í•s—v‚Ĺ‚ ‚é‚Ć•ń‚ł‚ę‚Ä‚˘‚é1jB

ˆę•űAis’_”XŠŕ‚Ĺ‚Í’_ŠÇŽüˆÍ‚ĚƒŠƒ“ƒpŠÇ‚ŞŽîᇐi“WŒo˜H‚Ĺ‚ ‚é‚ą‚ƁA”ń˜A‘ą“I‚ȩ̏\“ńŽw’°ŠÔ–Œ“ŕ‚ĚŽîᇐi“W‚Ş”F‚ß‚ç‚ę‚é‚ą‚Ć‚Š‚çA‘S—áŠĚŠO’_ŠÇŘœ‚đs‚¤‚ׂŤ‚Ĺ‚ ‚é‚Ć‚˘‚¤ˆÓŒŠ2, 3j‚âAƒŠƒ“ƒpß“]ˆÚ—zŤ—áA‡—ŹˆŮí‡•š—áAčň•”‚É‘śÝ‚ˇ‚é’_”XŠŕA_ŒoŽüˆÍZ‚đ”F‚ß‚ç‚ę‚éÇ—á‚É‚ÍŠĚŠO’_ŠÇ‡•šŘœ‚đs‚¤‚ׂŤ‚Ĺ‚ ‚é‚Ć‚Ě•ń‚Ş‚Č‚ł‚ę‚Ä‚Ť‚˝4-6jB‚ą‚ę‚ç‚Š‚çAŒťŽž“_‚Ĺ‚Í—\–h“IŠĚŠO’_ŠÇŘœ‚ʼnśŒb‚đŽó‚Ż‚éÇ—á‚Ş–ł‚˘‚Ć‚ÍŒž‚Ś‚Č‚˘‚ށAp‘O‘I•Ę‚ˇ‚é‚ą‚Ć‚Í˘“ď‚Ĺ‚ ‚éB

—\–h“IŠĚŠO’_ŠÇŘœ‚đ„§‚ˇ‚é—§ę‚Š‚ç‚́A–D‡•s‘S‚Č‚Ç‚Ě‡•šÇ‚Ě•p“x‚Ş’á‚­ˆŔ‘S‚Ĺ‚ ‚é‚ą‚Ć‚đ‚ť‚Ě——R‚Ć‚ľ‚Ä‚˘‚é‚ŞA’_ŠÇ‹ó’°•Ť‡Œă‚É’_ŠÇ‰Š‚đ•š”­‚ˇ‚é‚ą‚Ć‚Í‹H‚Ĺ‚Í‚Č‚­A”ńŠg’Ł’_ŠÇ‚̍‡•šŘœ‚ɂ͐Td‚ȑΉž‚Ş•K—v‚ĆŽv‚í‚ę‚é6-8jB

ŽQl•śŒŁ

1j Araida T, Higuchi R, Hamano M, Kodera Y, Takeshita N, Ota T, Yoshikawa T, Yamamoto M, Takasaki K. Should the extrahepatic bile duct be resected or preserved in R0 radical surgery for advanced gallbladder carcinoma? Results of a Japanese Society of Biliary Surgery Survey: a multicenter study. Surg Today 2009; 39: 770-9.

2j Tsukada K, Hatakeyama K, Kurosaki I, Uchida K, Shirai Y, Muto T, Yoshida K. Outcome of radical surgery for carcinoma of the gallbladder according to the TNM stage. Surgery 1996; 120: 816-21.

3j Shimizu Y, Ohtsuka M, Ito H, Kimura F, Shimizu H, Togawa A, Yoshidome H, Kato A, Miyazaki M. Should the extrahepatic bile duct be resected for locally advanced gallbladder cancer? Surgery 2004; 136: 1012-7.

4j Kokudo N, Makuuchi M, Natori T, Sakamoto Y, Yamamoto J, Seki M, Noie T, Sugawara Y, Imamura H, Asahara S, Ikari T. Strategies for surgical treatment of gallbladder carcinoma based on information available before resection. 2003; 138: 741-50.

5j Sakamoto Y, Kosuge T, Shimada K, Sano T, Hibi T, Yamamoto J, Takayama T, Makuuchi M. Clinical significance of extrahepatic bile duct resection for advanced gallbladder cancer. 2006; 94; 298-306.

6j Suzuki S, Yokoi Y, Kurachi K, Inaba K, Ota S, Azuma M, Konno H, Baba S, Nakamura S. Appraisal of surgical treatment for pT2 gallbladder carcinomas. World J Surg 2004; 28: 160-5.

7j de Castro SM, Kuhlmann KF, Busch OR, van Delden OM, Lameris JS, van Gulik TM, Overtop H, Gouma DJ. Incidence and management of biliary leakage after hepaticojejunostomy. J Gastrointest Surg 2005; 9: 1163-1173.

8j Nagino M, Nishio T, Egata T, Yokoyama Y, Igami T, Nimura Y. Intrahepatic cholangiojejunostomy following hepatobiliary resection. Br J Surg 2007; 94: 70-77.


ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ35
’_“šŠŕ‚É‚¨‚˘‚Ăǂ̂悤‚ČÇ—á‚ɩ̐؏œ‚𔺂¤äX“ޏ\“ńŽw’°Řœi‚˘‚í‚ä‚éHPDj‚ĚˆÓ‹`‚Ş‚ ‚é‚ŠH

L”͈͒_ŠÇŠŕŞŽĄŘœ—á‚ł́AHPD‚É‚ć‚č—ǍD‚Č—\Œă‚Ş•ń‚ł‚ę‚Ä‚˘‚éB’_”XŠŕA“Á‚ɕǐŤ‰Šát—á‚ł́AHPDi‰E—tŘœˆČă‚̩̐؏œ‚𔺂¤HPDj‚Ě“K‰ž‚͐Td‚É”ť’f‚ˇ‚é‚ׂŤ‚Ĺ‚ ‚éB

„§“x‚Č‚ľ

‰đŕ

ŠĚŘœ‚𔺂¤äX“ޏ\“ńŽw’°Řœ; HPDihepatopancreatoduodenectomyj‚́AL”͂ɐi“W‚ľ‚˝’_ŠÇŠŕ‚â’_”XŠŕ‚ɑ΂ľ‚ÄŽ{s‚ł‚ęA1990 ”N‘ă‚Š‚ç2000 ”N‚Ü‚Ĺ‚É­”—á‚Č‚Ş‚ç5 ”NˆČăś‘ś—á‚Ě•ń‚Ş‚ł‚ę‚é‚悤‚É‚Č‚Á‚˝1-5jBHPD ‚É‚ć‚čR0 Řœ‚ލs‚í‚ę‚ę‚Η\Œă‚Ş”äŠr“I—ǍD‚Ć‚Ě•ń‚ŕ•Ą””F‚ß‚ç‚ę‚é‚Ş6-9jA’_”XŠŕ‚Ĺ‚Í—\Œă‚̉ü‘P‚ÉŒ‹‚т‚Š‚Č‚Š‚Á‚˝‚Ć‚Ě•ń‚ŕ‚ ‚é10jB

HPD ‚ÉŠÖ‚ˇ‚éĹ‹ß‚Ě•ń‚Š‚ç‚́AL”͈͒_ŠÇŠŕ‚đHPD ‚ĹŞŽĄ“I‚ɐ؏œ‚Ĺ‚Ť‚ę‚΁AHPD ‚Í‚ť‚Ě—\ŒăŒüă‚ÉŠń—^‚ˇ‚é‰Â”\Ť‚Ş‚ ‚éB‚˝‚ž‚ľA’_”XŠŕA“Á‚ɕǐŤ‰Šát‚𔺂¤Ç—á‚ł́A‰ź‚ÉHPD ‚đs‚Á‚Ä‚ŕ—ǍD‚Č—\Œă‚Ş“ž‚ç‚ę‚Ä‚¨‚炸A‚ť‚Ě“K‰ž”ť’f‚͐Td‚É‚Č‚ł‚ę‚é‚ׂŤ‚Ĺ‚ ‚éB

HPD ‚ĚÝ‰@Ž€–S—Ś‚Íhigh volume center ‚Ĺ‚ÍŒ¸­‚ľ‚‚‚ ‚é‚ŞA‡•šÇ—Ś‚͈ˑR‚Ć‚ľ‚č‚‚­A“Á‚ÉŠĚ•s‘SAäX‰tᑁAŠ´őŤ‡•šÇA• …‚É’ˆÓ‚ˇ‚ׂŤ‚Ĺ‚ ‚éB‚Š‚Š‚éó‹ľ‚đ“Ľ‚Ü‚Ś‚é‚ƁAŠĚ—tŘœˆČă‚̩̐؏œ‚𔺂¤HPD ‚́Ahigh volume center ‚ōs‚í‚ę‚é‚ą‚Ć‚ŞŠŠ‚ß‚ç‚ę‚éB

’_“šŠŕ‚É‚¨‚Ż‚éHPD ‚ĚˆÓ‹`‚ɂ‚˘‚Ä‚ÍěŹˆĎˆő‚É‚ć‚铢‹c‚Ĺ‚ŕˆÓŒŠ‚Ş•Ş‚Š‚ęC„§“x‚đ‚‚Ż‚é‚ą‚Ć‚ÉˆĎˆő‰ď‚Ć‚ľ‚č‡ˆÓ‚Ş“ž‚ç‚ę‚Č‚Š‚Á‚˝‚˝‚߁C–{CQ ‚͐„§“x‚Č‚ľ‚Ć‚ľ‚˝B

ŽQl•śŒŁ

1j Nimura Y, Hayakawa N, Kamiya J, Maeda S, Kondo S, Yasui A, et al. Hepatopancreatoduodenectomy for advanced carcinoma of the biliary tract. Hepatogastroenterology 1991; 38: 170-175.

2j Nakamura S, Suzuki S, Serizawa A, Sakaguchi T, Konno H, Baba S, et al. Hepatopancreatoduodenectomy for superficially spreading bile duct carcinoma: a report of two 5 year survivals. Hepatogastroenterology 1996; 43: 138-142.

3j Shirai Y, Ohtani T, Tsukada K, Hatakeyama K. Combined pancreaticoduodenectomy and hepatectomy for patients with locally advanced gallbladder carcinoma: long term results. Cancer 1997; 80: 1904-1909.

4j Kurosaki I, Hatakeyama K, Tsukada K, Date K, Tomiyama T. Major hepatectomy combined with pylorus-preserving pancreatoduodenectomy for middle bile duct cancer with multiple lymph node metastases: a case report of 5-year survival. Hepatogastroenterology 1999; 49: 1623-1626.

5j Tomono H, Fujioka S, Kato K, Aikawa K, Nimura Y. Hepatopancreatoduodenectomy for squamous cell carcinoma of the gallbladder. Hepatogastroenterology 2000; 47: 945-947.

6j Yoshimi F, Asato Y, Amemiya R, Shioyama Y, Itabashi M. Comparison between pancreatoduodenectomy and hepatopancreatoduodenectomy for bile duct cancer. Hepatogastroenterology 2001; 48: 994-998.

7j Kaneoka Y, Yamaguchi A, Isogai M, Kumada T. Survival benefit of hepatopancreatoduodenectomy for cholangiocarcinoma in comparison to hepatectomy or pancreatrtoduodenectomy. World J Surg 2010; 34: 2662-70.

8j Lim CS, Jang JY, Lee SE, kang MJ, Kim SW. Reappraisal of hepatopancreatoduodenectomy as a treatment modality for bile duct and gallbladder cancer. J Gastrointest Surg 2012; 16: 1012-1018.

9j Ebata T, Yokoyama Y, Igami T, Sugawara G, Takahashi Y, Nimura Y, Nagino M. Hepatopancreatoduodenectomy for cholangiocarcinoma. A single-center review of 85 consecutive patients. Ann Surg 2012; 256: 297-305.

10j Kaneoka Y, Yamaguchi A, Isogai M. Hepatopancreatoduodenectomy: its suitability for bile duct cancer versus gallbladder cancer. J Hepatobiliary pancreat Surg 2007; 14: 142-148.


‰ťŠw—Ă–@

ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ36
Řœ•s”\’_“šŠŕ‚ɑ΂ˇ‚éƒtƒ@[ƒXƒgƒ‰ƒCƒ“‚̉ťŠw—Ă–@‚͉˝‚ŠH

Řœ•s”\’_“šŠŕ‚ɑ΂ˇ‚éƒtƒ@[ƒXƒgƒ‰ƒCƒ“‚̉ťŠw—Ă–@‚Ć‚ľ‚ẮAƒQƒ€ƒVƒ^ƒrƒ“‚ĆƒVƒXƒvƒ‰ƒ`ƒ“•š—p—Ă–@‚ސ„§‚ł‚ę‚éB

„§“x1@ƒGƒrƒfƒ“ƒXƒŒƒxƒ‹A

‰đŕ

Řœ•s”\’_“šŠŕŠłŽŇ‚Ě—\Œă‚Í‚Ť‚í‚ß‚Ä•s—Ç‚Ĺ‚ ‚čA—LŒř‚Č”ńŽčp—Ă–@‚ĚŠJ”­‚Ş–]‚Ü‚ę‚Ä‚Ť‚˝B‚ľ‚Š‚ľA‚ą‚ę‚܂ŁAŘœ•s”\’_“šŠŕ‚ɑ΂ľ‚čs‚í‚ę‚Ä‚Ť‚˝—Տ°ŽŽŒą‚́A’PŒQ‚ĚŽŽŒą‚⏬‹K–Í‚Č”äŠrŽŽŒą‚Ě‚Ý‚Ĺ‘ĺ‹K–Í‚Č‘ćⅢ ‘ŠŽŽŒą‚Ě•ń‚ÍĹ‹ß‚Ü‚ĹŠF–ł‚Ĺ‚ ‚Á‚˝B

ƒQƒ€ƒVƒ^ƒrƒ“‚́A‘ćⅡ‘ŠŽŽŒą‚̐ŹŃ1j‚ć‚č’_“šŠŕ‚ɑ΂ˇ‚é“K‰ž‚Ş‰ä‚Ş‘‚Ĺ‚Í”F‚ß‚ç‚ęA’_“š‚Ş‚ń‚Ş—Ő°“I‚ÉäX‚Ş‚ń‚É—ŢŽ—‚̐ŤŠi‚đ—L‚ľA–{–ňÜ‚ŞäX‚Ş‚ń‚ɑ΂ˇ‚é•W€ŽĄ—Ă–ň‚Ĺ‚ ‚é‚ą‚Ć‚Č‚Ç‚Š‚çA’_“šŠŕ‚ɑ΂ˇ‚éƒRƒ~ƒ…ƒjƒeƒB[ƒXƒ^ƒ“ƒ_[ƒh‚Ć‚ľ‚č‘“ŕŠO‚ĹŽó‚Ż“ü‚ę‚ç‚ę‚Ä‚Ť‚˝B‚Ü‚˝‰ä‚ލ‘‚Ĺ‚ÍS-1 ‚ŕ‚Q‚‚̑ćⅡ‘ŠŽŽŒą‚ĚŒ‹‰Ę2-3jA’_“š‚Ş‚ń‚ɑ΂ˇ‚é“K‰ž‚Ş”F‚ß‚ç‚ę‚Ä‚¨‚čAƒQƒ€ƒVƒ^ƒrƒ“‚ĆS-1 ‚Ě•š—p—Ă–@‚Ě‘ćⅡ‘ŠŽŽŒą‚ɂ‚˘‚Ä‚ŕ•Ą”ŽŔŽ{‚ł‚ęA”äŠr“I—ǍD‚ȐŹŃ‚Ş•ń‚ł‚ę‚Ä‚¨‚č4-7jAŒťÝ‘ćⅢ ‘ŠŽŽŒą‚ސi‚ß‚ç‚ę‚Ä‚˘‚éB

‰p‘‚Ĺ‚ÍŘœ•s”\’_“šŠŕiŠĚ“ŕ’_ŠÇŠŕAŠĚŠO’_ŠÇŠŕA’_”XŠŕA“ű“Ş•”Šŕj‚ɑ΂ˇ‚éƒQƒ€ƒVƒ^ƒrƒ“’PÜ—Ă–@‚ĆƒQƒ€ƒVƒ^ƒrƒ“‚ĆƒVƒXƒvƒ‰ƒ`ƒ“•š—p—Ă–@iGC —Ă–@j‚Ć‚đ”äŠr‚ˇ‚郉ƒ“ƒ_ƒ€‰ť‘ćⅡ‘ŠŽŽŒąiABC-01 ŽŽŒąj8jA‘ćⅢ ‘ŠŽŽŒąiABC-02 ŽŽŒąj9j‚ŞŽŔŽ{‚ł‚ęAGC —Ă–@ŒQ‚̐ś‘śŠúŠÔ‚ރQƒ€ƒVƒ^ƒrƒ“’PÜ—Ă–@ŒQ‚Ě‚ť‚ę‚Ć”äŠr‚ľ‚Ä—LˆÓ‚ɗǍD‚Ĺ‚ ‚é‚ą‚Ć‚Ş•ń‚ł‚ę‚˝BƒuƒŠƒbƒWƒ“ƒOƒXƒ^ƒfƒB‚Ć‚ľ‚āA“ú–{‚Ĺ‚ŕŘœ•s”\’_“šŠŕiŠĚ“ŕ’_ŠÇŠŕAŠĚŠO’_ŠÇŠŕA’_”XŠŕA“ű“Ş•”ŠŕjŠłŽŇ‚đ‘ÎŰ‚Éƒ‰ƒ“ƒ_ƒ€‰ť‘ćⅡ‘ŠŽŽŒąiBT22 ŽŽŒąj‚ލs‚í‚ę10jAABC-02 ŽŽŒą‚Ć—ŢŽ—‚ˇ‚éŒXŒü‚Ş”F‚ß‚ç‚ę‚˝BGC —Ă–@‚Í‘ćⅢ ‘ŠŽŽŒą‚ʼn„–˝Œř‰Ę‚ŞŽŚ‚ł‚ę‚˝‰‚ß‚Ä‚ĚƒŒƒWƒƒ“‚Ĺ‚ ‚čA‚Ü‚˝d“ĂȓŐŤ‚ޏ­‚Č‚­ŠO—ˆ‚Ĺ‚ĚŽŔŽ{‚ŕ‰Â”\‚Ĺ‚ ‚é‚ą‚Ć‚Š‚犳ŽŇ•‰’S‚ŕ”äŠr“IŒy‚­A‘Ű“I‚Č•W€ŽĄ—Ă‚ĆŒťÝl‚Ś‚ç‚ę‚Ä‚˘‚éB

ŽQl•śŒŁ

1j Okusaka T, Ishii H, Funakoshi A, Yamao K, Ohkawa S, Saito S, Saito H, Tsuyuguchi T. Phase Ⅱ study of single-agent gemcitabine in patients with advanced biliary tract cancer. Cancer Chemother Pharmacol 2006; 57: 647-53.

2j Ueno H, Okusaka T, Ikeda M, Takezako Y, Morizane C. Phase Ⅱ study of S-1 in patients with advanced biliary tract cancer. Br J Cancer 2004; 91: 1769-74.

3j Furuse J, Okusaka T, Boku N, Ohkawa S, Sawaki A, Masumoto T, Funakoshi A. S-1 monotherapy as first-line treatment in patients with advanced biliary tract cancer: a multicenter phase Ⅱ study. Cancer Chemother Pharmacol 2008; 62: 849-55.

4j Kanai M, Yoshimura K, Tsumura T, Asada M, Suzuki C, Niimi M, Matsumoto S, Nishimura T, Nitta T, Yasuchika K, Taura K, Mori Y, Hamada A, Inoue N, Tada S, Yanagihara K, Yazumi S, Osaki Y, Chiba T, Ikai I, Fukushima M, Uemoto S, Hatano E. A multi-institution phase Ⅱ study of gemcitabine/S-1 combination chemotherapy for patients with advanced biliary tract cancer. Cancer Chemother Pharmacol 2011; 67: 1429-34.

5j Sasaki T, Isayama H, Nakai Y, Ito Y, Kogure H, Togawa O, Toda N, Yasuda I, Hasebe O, Maetani I, Sasahira N, Hirano K, Tsujino T, Tada M, Omata M. Multicenter, phase Ⅱ study of gemcitabine and S-1 combination chemotherapy in patients with advanced biliary tract cancer. Cancer Chemother Pharmacol 2010; 65: 1101-7.

6j Morizane C, Okusaka T, Mizusawa J, Takashima A, Ueno M, Ikeda M, Hamamoto Y, Ishii H, Boku N, Furuse J. Randomized phase Ⅱ study of gemcitabine plus S-1 versus S-1 in advanced biliary tract cancer: a Japan Clinical Oncology Group trial (JCOG 0805). Cancer Sci 2013; 104: 1211-6.

7j Sasaki T1, Isayama H, Nakai Y, Ito Y, Yasuda I, Toda N, Kogure H, Hanada K, Maguchi H, Sasahira N, Kamada H, Mukai T, Okabe Y, Hasebe O, Maetani I, Koike K. A randomized phase Ⅱ study of gemcitabine and S-1 combination therapy versus gemcitabine monotherapy for advanced biliary tract cancer. Cancer Chemother Pharmacol. 2013; 71: 973-9.

8j Valle JW, Wasan H, Johnson P, Jones E, Dixon L, Swindell R, Baka S, Maraveyas A, Corrie P, Falk S, Gollins S, Lofts F, Evans L, Meyer T, Anthoney A, Iveson T, Highley M, Osborne R, Bridgewater J. Gemcitabine alone or in combination with cisplatin in patients with advanced or metastatic cholangiocarcinomas or other biliary tract tumours: a multicentre randomised phase Ⅱ study -- the UK ABC-01 Study. Br J Cancer 2009; 101: 621-627

9j Valle J, Wasan H, Palmer DH, Cunningham D, Anthoney A, Maraveyas A, Madhusudan S, Iveson T, Hughes S, Pereira SP, Roughton M, Bridgewater J; ABC-02 Trial Investigators. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med. 2010; 362: 1273-81.

10j Okusaka T, Nakachi K, Fukutomi A, Mizuno N, Ohkawa S, Funakoshi A, Nagino M, Kondo S, Nagaoka S, Funai J, Koshiji M, Nambu Y, Furuse J, Miyazaki M, Nimura Y. Gemcitabine alone or in combination with cisplatin in patients with biliary tract cancer: a comparative multicentre study in Japan. Br J Cancer 2010; 103: 469-74.


ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ37
Řœ•s”\’_“šŠŕ‚ɑ΂ˇ‚éƒZƒJƒ“ƒhƒ‰ƒCƒ“‚̉ťŠw—Ă–@‚͉˝‚ŠH

Řœ•s”\’_“šŠŕ‚ɑ΂ˇ‚éƒZƒJƒ“ƒhƒ‰ƒCƒ“‚̉ťŠw—Ă–@‚đs‚¤‚ą‚Ć‚Íl—ś‚ľ‚Ä‚ŕ‚悢‚ށAŒťó‚ł͐„§‚ˇ‚ׂŤƒŒƒWƒƒ“‚ÍŠm—§‚ł‚ę‚Ä‚˘‚Č‚˘B

„§“x‚Č‚ľ

‰đŕ

Řœ•s”\’_“šŠŕ‚ɑ΂ˇ‚鉝Šw—Ă–@‚ŁA–{–M‚Ĺ•ŰŒŻ“K‰ž‚Ć‚Č‚Á‚Ä‚˘‚éŽĺ‚ČƒŒƒWƒƒ“‚̓Qƒ€ƒVƒ^ƒrƒ“iGEMj’P“ƁAS-1 ’P“ƁAƒQƒ€ƒVƒ^ƒrƒ“‚ĆƒVƒXƒvƒ‰ƒ`ƒ“iGEM{CDDPj•š—p—Ă–@‚Ĺ‚ ‚éB‚ą‚Ě‚˝‚߁A–{–M‚Ĺ‚ĚƒZƒJƒ“ƒhƒ‰ƒCƒ“‚̉ťŠw—Ă–@‚ɂ‚˘‚ẮA‚ą‚ę‚ç‚ĚƒŒƒWƒƒ“‚đŽg—p‚ľ‚čs‚í‚ę‚Ä‚˘‚éB‚ľ‚Š‚ľAŒťÝ‚Ě‚Ć‚ą‚ëA­”—á‚Ě‘ćⅡ‘ŠŽŽŒą‚Ş•ń‚ł‚ęA‚ ‚é’ö“x‚ĚŽĄ—ĂŒř‰Ę‚ŞŽŚ‚ł‚ę‚Ä‚¨‚č1-8jAŽ{s‰Â”\‚ČÇ—á‚Ĺ‚ÍƒZƒJƒ“ƒhƒ‰ƒCƒ“‰ťŠw—Ă–@‚Ě“ą“ü‚͍l—ś‚ľ‚Ä‚ŕ—Ç‚˘‚ƍl‚Ś‚ç‚ę‚é‚ŞA‚˘‚Ü‚ž\•Ş‚ČƒGƒrƒfƒ“ƒX‚͍\’z‚ł‚ę‚Ä‚˘‚Č‚˘B‚Ü‚˝ƒZƒJƒ“ƒhƒ‰ƒCƒ“‚̉ťŠw—Ă–@‚Ć–łŽĄ—ÁiŽxŽ—Ă–@j‚Ƃ𒟐ڔäŠr‚ľ‚˝—Տ°ŽŽŒą‚ŕs‚í‚ę‚Ä‚¨‚炸AĄŒăƒZƒJƒ“ƒhƒ‰ƒCƒ“‚̉ťŠw—Ă–@‚Ş–{“–‚ɐś‘śŠúŠÔ‚̉„’ˇ‚ÉŠń—^‚ˇ‚é‚ŠŒŸŘ‚ľ‚Ä‚˘‚­•K—v‚Ş‚ ‚éB

’_“šŠŕ‚̉ťŠw—Ă–@‚̐ŹŃ‚ÍŠłŽŇ•ęW’c‚Ě”wŒiˆöŽq‚É‘ĺ‚Ť‚­ś‰E‚ł‚ę‚éBŒťÝ”­•\‚ł‚ę‚Ä‚˘‚éƒZƒJƒ“ƒhƒ‰ƒCƒ“‰ťŠw—Ă–@‚Ě‘ćⅡ‘ŠŽŽŒą‚́A‚ť‚ę‚ź‚ę‚É”wŒiˆöŽq‚ŞˆŮ‚Č‚čA‚ť‚ĚŽĄ—ÐŹŃ‚đ’Pƒ‚É‚Í”äŠr‚Ĺ‚Ť‚Č‚˘‚˝‚߁AŒťÝ„§‚ˇ‚ׂŤƒŒƒWƒƒ“‚đŒˆ’č‚ˇ‚é‚ą‚Ć‚Í‚Ĺ‚Ť‚Č‚˘B

ŽQl•śŒŁ

1j Sasaki T, Isayama H, Yashima Y, Yagioka H, Kogure H, Arizumi T, et al. S-1 monotherapy in patients with advanced biliary tract cancer. Oncology 2009; 77: 71-74.

2j Suzuki E, Ikeda M, Okusaka T, Nakamori S, Ohkawa S, Nagakawa T, et al. A multicenter phase Ⅱ of S-1 in gemcitabine refractory biliary tract cancer. J Clin Oncol 2010; 28: 15s (suppl; abstr 4145).

3j Sasaki T, Isayama H, Nakai Y, Mizuno S, Yamamoto K, Yagioka H, et al. Multicenter phase Ⅱ study of S-1 monotherapy as second-line chemotherapy for advanced biliary tract cancer refractory to gemcitabine. Invest New Drugs 2012; 30: 708-713.

4j Oh SY, Jeong CY, Hong SC, Kim TH, Ha CY, Kim HJ, et al. Phase Ⅱ study of second line gemcitabine single chemotherapy for biliary tract cancer patients with 5-fluorouracil refractoriness. Invest New Drugs 2011; 29: 1066-1072.

5j Sasaki T, Isayama H, Nakai Y, Mizuno S, Yamamoto K, Yagioka H, et al. Feasibility study of gemcitabine and cisplatin combination chemotherapy for patients with refractory biliary tract cancer. Invest New Drugs 2011; 29: 1488-1493.

6j Paule B, Herelle MO, Rage E, Ducreux M, Adam R, Guettier C, et al. Cetuximab plus gemcitabine-oxaliplatin (GEMOX) in patients with refractory advanced intrahepatic cholangiocarcinomas. Oncology 2007; 72: 105-110.

7j Yi JH, Thongprasert S, Lee J, Doval DC, Park SH, Park JO, et al. A phase Ⅱ study of sunitinib as a second-line treatment in advanced biliary tract carcinoma: a multicentre, multinational study. Eur J Cancer 2012; 48: 196-201.

8j Roth A, Schleyer E, Schoppmeyer K, Kluge R, Wittekind C, Mö ssner J, et al. Imatinib mesylate for palliative second-line treatment of advanced biliary tract cancer: a bicentric phase Ⅱ study. Onkologie 2011; 34: 469-470.


ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ38
pŒă•â•‰ťŠw—Ă–@‚đs‚¤‚ą‚Ƃ͐„§‚ł‚ę‚é‚Š?

pŒă•â•‰ťŠw—Ă–@‚Ě—L—pŤ‚đŽŚ‚ľ‚˝ƒGƒrƒfƒ“ƒX‚Í‚Č‚˘B

„§“x‚Č‚ľ

‰đŕ

’_“šŠŕ‚ÍŞŽĄŘœ‚މ”\‚Ĺ‚ ‚Á‚Ä‚ŕ‘ŠúÄ”­—á‚Ş‘˝‚­A‚ť‚Ě—\Œă‚Í•s—Ç‚Ĺ‚ ‚éBŘœŹŃ‚ĚŒüă‚Ě‚˝‚߂ɂ́ApŒă•â•—Ă–@‚É‚ć‚éÄ”­–hŽ~‚É‘ĺ‚Ť‚ČŠú‘Ň‚ŞŽ‚˝‚ę‚Ä‚˘‚é‚ŞA‚ą‚ę‚Ü‚ĹpŒă•â•—Ă–@‚Ě—L—pŤ‚đŒŸŘ‚ˇ‚é‘ĺ‹K–Í‚Čƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚͍s‚í‚ę‚Ä‚˘‚Č‚˘B‚í‚Ş‘‚Ĺ‚Ímytomycin C +5-fluorouracil •š—p—Ă–@iMF—Ă–@j‚ĆŽčp’P“Ć‚Ć‚Ě”äŠrŽŽŒą‚ލs‚í‚ę1jA’_”XŠŕ‚Ĺ‚ÍMF ŒQ‚Ĺ—LˆÓ‚ɗǍD‚Č5 ”Nś‘śŠ„‡‚Ş•ń‚ł‚ę‚Ä‚˘‚éB‚ľ‚Š‚ľA–{ŽŽŒą‚Ĺ‚ÍŘœ‚ĚŽĄ–ü“x•Ę‚ĚŒŸ“˘‚É‚ć‚é‚Ć—LˆÓˇ‚đ”F‚ß‚˝‚Ě‚Í”ńŽĄ–üŘœ—á‚Ě‚Ý‚Ĺ‚ ‚čAintent-to-treat ‰đÍ‚Ĺ‚Í—LˆÓ‚ȍˇ‚Í“ž‚ç‚ꂸA’_ŠÇŠŕA“ű“Ş•”Šŕ‚Ĺ‚Íˇ‚Í”F‚ß‚ç‚ę‚Č‚Š‚Á‚˝B‚ą‚ę‚ç‚ĚŒ‹‰Ę‚Š‚çMF —Ă–@‚Í’_“šŠŕpŒă•â•—Ă–@‚Ć‚ľ‚Ĉę”Ę—Ő°‚Ĺ—p‚˘‚ç‚ę‚Ä‚¨‚炸AˆË‘R„§‚ł‚ę‚é’_“šŠŕpŒă•â•—Ă–@‚ÍŠm—§‚ľ‚Ä‚˘‚Č‚˘B

Řœ•s”\is’_“šŠŕ‚đ‘ÎŰ‚Ć‚ľ‚˝‰ťŠw—Ă–@‚ł́AƒQƒ€ƒVƒ^ƒrƒ“iGEMj’P“ƁAS-1 ’P“ƁAƒQƒ€ƒVƒ^ƒrƒ“‚ĆƒVƒXƒvƒ‰ƒ`ƒ“iGEM{CDDPj•š—p—Ă–@‚Č‚Ç—LŒř‚ČŽĄ—Ă–@‚Ş•ŰŒŻ“K—p‚ɏł”F‚ł‚ęAÇ—áWĎŒ¤‹†‚âAŒă‚ëŒü‚ŤŠĎŽ@Œ¤‹†‚ĚŒ‹‰Ę‚Š‚çpŒă•â•—Ă–@‚Ĺ‚Ě—L—pŤ‚ŞŠú‘Ň‚ł‚ę‚Ä‚Ť‚Ä‚˘‚é2, 3jB‚í‚Ş‘‚É‚¨‚˘‚āA’_ŠÇŠŕ‚đ‘ÎŰ‚Ć‚ľ‚˝ƒQƒ€ƒVƒ^ƒrƒ“‚âAŠĚ“ŕ’_ŠÇŠŕAŠĚŠO’_ŠÇŠŕA’_”XŠŕA“ű“Ş•”Šŕ‚đ‘ÎŰ‚Ć‚ľ‚˝S-1 ‚đ—p‚˘‚˝pŒă•â•—Ă–@‚Ě‘ćⅢ ‘ŠŽŽŒą‚ŞŽŔŽ{‚ł‚ę‚Ä‚¨‚čAĄŒăpŒă•â•—Ă–@‚Ě—L—pŤ‚Ş–ž‚ç‚Š‚Ć‚Č‚čA•W€ŽĄ—Ă‚ŞŠm—§‚ˇ‚é‚ŕ‚Ě‚ĆŠú‘Ň‚ł‚ę‚éB‚ľ‚Š‚ľAŒťŽž“_‚ł͐„§‚ł‚ę‚郌ƒWƒƒ“‚Í‚Č‚­ApŒă•â•—Ă–@‚ÍŽŽŒą“IŽĄ—Ă‚Ć‚˘‚¤ˆĘ’u‚Ă‚Ż‚ĚŒł‚ŐTd‚ÉŽŔŽ{‚ˇ‚é‚ׂŤ‚Ĺ‚ ‚éB

’_“šŠŕ‚É‚¨‚Ż‚épŒă•â•‰ťŠw—Ă–@‚ĚˆÓ‹`‚ɂ‚˘‚Ä‚ÍěŹˆĎˆő‚É‚ć‚铢‹c‚Ĺ‚ŕˆÓŒŠ‚Ş•Ş‚Š‚ęC„§“x‚đ‚‚Ż‚é‚ą‚Ć‚ÉˆĎˆő‰ď‚Ć‚ľ‚č‡ˆÓ‚Ş“ž‚ç‚ę‚Č‚Š‚Á‚˝‚˝‚߁C–{CQ‚͐„§“x‚Č‚ľ‚Ć‚ľ‚˝B

ŽQl•śŒŁ

1j Takada T, Amano H, Yasuda H, Nimura Y, Matsushiro T, Kato H, Nagakawa T, Nakayama T; Study Group of Surgical Adjuvant Therapy for Carcinomas of the Pancreas and Biliary Tract. Is postoperative adjuvant chemotherapy useful for gallbladder carcinoma? A phase Ⅲ multicenter prospective randomized controlled trial in patients with resected pancreaticobiliary carcinoma. Cancer 2002; 95: 1685-95.

2j Murakami Y, Uemura K, Sudo T, Hayashidani Y, Hashimoto Y, Nakamura H, Nakashima A, Sueda T. Adjuvant gemcitabine plus S-1 chemotherapy improves survival after aggressive surgical resection for advanced biliary carcinoma. Ann Surg. 2009; 250: 950-6.

3j Murakami Y, Uemura K, Sudo T, Hayashidani Y, Hashimoto Y, Nakamura H, Nakashima A, Sueda T. Gemcitabine-based adjuvant chemotherapy improves survival after aggressive surgery for hilar cholangiocarcinoma. J Gastrointest Surg. 2009; 13: 1470-9.


•úŽËüŽĄ—Ă

ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ39
Řœ•s”\’_“šŠŕ‚É•úŽËü—Ă–@‚Í—L—p‚ŠH

Řœ•s”\’_“šŠŕÇ—á‚ɑ΂ľ‚Ä•úŽËü—Ă–@‚đs‚¤‚ą‚Ć‚đl—ś‚ľ‚Ä‚ŕ—Ç‚˘B

„§“x2@ƒGƒrƒfƒ“ƒXƒŒƒxƒ‹C

‰đŕ

Řœ•s”\’_“šŠŕ‚ɑ΂ˇ‚é•úŽËü—Ă–@‚Ě–Ú“I‚́C‰„–˝iŒĆ‘§“IŽĄ—Áj‚ ‚邢‚̓Xƒeƒ“ƒgŠJ‘śŤˆŰŽCŒ¸‰ŠCáu’Ɋɘai‘ΏǓIŽĄ—Áj‚Č‚Ç‚Ĺ‚ ‚éB•úŽËü—Ă–@‚Í‘ź‚ĚŒĆ‘§“IŽĄ—Ă‚ ‚邢‚ÍŽxŽ—Ă–@‚Ć”äŠr‚ľ‚ĉ„–˝Œř‰Ę‚Ş‚ ‚é‚Ć‚ˇ‚é•ń‚Í‘˝‚˘‚Ş1-6jA‘ĺ‹K–Í‚Čƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚ÍŽŔŒť‚ľ‚Ä‚˘‚Č‚˘B

’_“šŠŕ‚ɑ΂ľ‚Ă͈ę”Ę“I‚ÉŠOĆŽË‚ލs‚í‚ę‚Ä‚˘‚é‚ŞAÁ‰ťŠÇ‚âŇ‘‚Č‚Ç‚ĚŽüˆÍ‘ŸŠí‘Ď—eü—Ę‚đl—ś‚ľ‚āA’Ęí•ŞŠ„ĆŽË‚Ĺ‚Í‘ü—Ę50Gy ’ö“x‚Ş—p‚˘‚ç‚ę‚éBo“ŕĆŽË‚ÍŽü•Ółí‘gD‚̐ü—Ę‚đŒ¸‚ś‚‚A•a•Ď•”‚ɍ‚ü—Ę‚đĆŽË‚Ĺ‚ŤC•›ě—p‚đ­‚Č‚­Œř‰Ę‚đ‚ ‚°‚é‚ą‚Ć‚ŞŠú‘Ň‚ł‚ę‚éB‚ľ‚Š‚ľAo“ŕĆŽË‚̐ü—Ę“Š—^•ű–@‚âAü—Ę•ŞŠ„‚É‚ŕ’č‚Ü‚Á‚˝‚ŕ‚Ě‚Í‚Č‚­A’_ŠÇ‰Š‚âÁ‰ťŠÇáŠQ‚Č‚Ç‚É’ˆÓ‚Ş•K—v‚Ĺ•W€“I‚Č•úŽËü—Ă–@‚ÍŠm—§‚ľ‚Ä‚˘‚Č‚˘BŠO•”ĆŽË‚≝Šw—Ă–@‚̐i“W‚É”ş‚˘‘“ŕ‚Ĺ‚Ío“ŕĆŽË‚ĚŽ{s”‚ŞŒ¸­‚ľ‚Ä‚˘‚éB‹ß”NCT ‚đ—p‚˘‚˝3 ŽŸŒłŽĄ—ĂŒv‰ć‚ވę”Ę“I‚É‚Č‚čA‚ł‚ç‚É’čˆĘĆŽËA‹­“x•Ď’˛•úŽËüŽĄ—ÁiIMRTj‚â—ąŽqüŽĄ—Ă‚Č‚Ç‚ĚŒ¤‹†‚ލs‚í‚ę‚Ä‚˘‚éB

•úŽËü—Ă–@‚ł́C‹ÇŠ§Œä‚É‚ć‚éƒXƒeƒ“ƒgŠJ‘śŤ‚ĚˆŰŽCáu’Ɋɘa‚Č‚Ç‚ŞŠú‘Ň‚Ĺ‚Ť‚é‚ą‚Ć‚ŕ—˜“_‚Ěˆę‚‚ł ‚éBŞŽĄŘœ•s”\—á‚ŁA‚—î‚ȂǂʼnťŠw—Ă–@‚Ě“K‰ž‚Ć‚Č‚ç‚Č‚˘ę‡AŽĄ—Ă•űjŒˆ’č‚ĚŰ‚É‚ÍC•úŽËü—Ă–@‚ɂ‚˘‚Äŕ–ž‚ˇ‚ׂŤ‚Ĺ‚ ‚éB

ŽQl•śŒŁ

1j Válek V, Kysela P, Kala Z, Kiss I, Tomásek J, Petera J. Brachytherapy and percutaneous stenting in the treatment of cholangiocarcinoma: a prospective randomised study. Eur J Radiol. 2007; 62: 175-9.

2j Bowling TE, Galbraith SM, Hatfield AR, Solano J, Spittle MF.@A retrospective comparison of endoscopic stenting alone with stenting and radiotherapy in non-resectable cholangiocarcinoma.@Gut. 1996; 39: 852-5.

3j Shinchi H, Takao S, Nishida H, Aikou T.@Length and quality of survival following external beam radiotherapy combined with expandable metallic stent for unresectable hilar cholangiocarcinoma.@J Surg Oncol. 2000 75: 89-94.

4j Takamura A, Saito H, Kamada T, Hiramatsu K, Takeuchi S, Hasegawa M, Miyamoto N.@Intraluminal low-dose-rate 192Ir brachytherapy combined with external beam radiotherapy and biliary stenting for unresectable extrahepatic bile duct carcinoma.@Int J Radiat Oncol Biol Phys. 2003; 57: 1357-65.

5j Shinohara ET, Guo M, Mitra N, Metz JM.@Brachytherapy in the treatment of cholangiocarcinoma. Int J Radiat Oncol Biol Phys. 2010; 78: 722-8.

6j Shinohara ET, Mitra N, Guo M, Metz JM Radiotherapy is associated with improved survival in adjuvant and palliative treatment of extrahepatic cholangiocarcinomas. Int J Radiat Oncol Biol Phys. 2009; 74: 1191-8.


ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ40
’_“šŠŕŘœ—á‚ɑ΂ˇ‚ép’†‚Ü‚˝‚͏pŒă‚Ě•úŽËü—Ă–@‚͐„§‚ł‚ę‚é‚ŠH

’_“šŠŕŘœŒă’f’[—zŤ—á‚ɑ΂ˇ‚é•úŽËü—Ă–@‚ĚŽ{s‚ɂ‚˘‚Ă͏\•Ş‚ȉȊw“IŞ‹’‚Ş‚Č‚­—Տ°Œ¤‹†‚Ć‚ľ‚čs‚¤‚Ě‚Ş–]‚Ü‚ľ‚˘B

„§“x‚Č‚ľ

‰đŕ

’_“šŠŕ‚͏pŒă•a—‘gDŠŒŠ‚É‚¨‚˘‚Ä”ńŽĄ–üŘœ‚Ć‚Č‚é•p“xA‚¨‚ć‚Ń‹ÇŠÄ”­—Ś‚ލ‚‚˘B‚ą‚Ě‚˝‚ߐ؏œÇ—á‚Ě‹ÇŠ§Œä—Ś‚đ‚‚ß‚é‚˝‚߁ApŒă‰ťŠw—Ă–@‚â•úŽËü—Ă–@‚ލs‚í‚ę‚é‚ą‚Ć‚Ş‘˝‚˘B•úŽËü—Ă–@‚Ě•ű–@‚͏p’†ĆŽËEŠOĆŽËEo“ŕĆŽË‚Ě3 ŽŇ‚đ‚ť‚ę‚ź‚ę’P“Ć‚Ü‚˝‚́C‚˘‚¸‚ę‚Š2 ŽŇ‚Ü‚˝‚Í3 ŽŇ‚Ě‘g‚ݍ‡‚í‚š‚ĹŽ{s‚ł‚ę‚Ä‚˘‚é‚ŞA‘ĺ‹K–Í‚Č”äŠrŽŽŒą‚Ě•ń‚Í‚Č‚˘B

’_”XŠŕ‚âƒtƒ@[ƒ^[“ű“ŞŠŕ‚đœ‚˘‚˝ŠĚŠO’_ŠÇŠŕ‚É‚¨‚˘‚ÄŠĎŽ@Œ¤‹†‚Ěƒƒ^ƒAƒiƒŠƒVƒX/ƒVƒXƒeƒ}ƒeƒBƒbƒNƒŒƒrƒ…[‚ł́ApŒăĆŽË‚Ş—LˆÓ‚É‘Sś‘ś—Ś‚đ‰ü‘P‚ˇ‚é‚ą‚Ć‚ŞŽŚ‚ł‚ęA”ÓŠú•úŽËü“ŐŤ‚Í’Ę‰ßáŠQ‚ ‚邢‚͏Á‰ťŠÇoŒŒ‚Ş2-9“‚ĆŒy”÷‚Ĺ‚ ‚Á‚˝1jB‚Ü‚˝•Ä‘‚Ě‘ĺ‹K–͉uŠw’˛¸ƒf[ƒ^ƒx[ƒXSEERiSurveillance, Epidemiology, and End Results databasej‚đ—p‚˘‚˝ŒŸ“˘‚Ĺ‚ŕpŒă•úŽËüŽĄ—Ă‚Ě—L—pŤ‚ŞŽŚ‚ł‚ę‚˝2jB“Ż—l‚ĚŒŸ“˘‚Ĺ’_”XŠŕ‚Ĺ‚ŕC“Á‚ÉT2 ˆČă‚ĚŒ´”­‘ƒ‚⃊ƒ“ƒpß“]ˆÚ—zŤ—á‚ŏpŒă•úŽËüŽĄ—Ă‚Ş—L—p‚Ĺ‚ ‚Á‚˝3jB

p’†ĆŽË‚Í–Ú“I‚Ć‚ˇ‚é•”ˆĘ‚ɐłŠm‚ÉĆŽË‰Â”\‚ŁC•úŽËüŠ´ŽóŤ‚̍‚‚˘ŽüˆÍłí‘gD‚đĆŽË–ě‚Š‚ç‚Í‚¸‚ˇ‚ą‚Ć‚Ş‚Ĺ‚Ť‚éBˆę”Ę“I‚É‚ÍŠOĆŽË‚Ş•š—p‚ł‚ę‚éB‚ľ‚Š‚ľA—L‰vŤ‚Ş”F‚ß‚ç‚ę‚˝‚Ć‚Ě•ń4j‚Ć”F‚ß‚ç‚ę‚Č‚Š‚Á‚˝‚Ć‚Ě•ń5j‚Ş‚ ‚čAĄŒă‚ĚŒŸ“˘‰Ű‘č‚Ĺ‚ ‚éB

ˆČă‚É‚ć‚č‘ĺ‹K–Í‚Čƒ‰ƒ“ƒ_ƒ€ŽŽŒą‚Ş–ł‚­•W€ŽĄ—Ă‚Ć‚ľ‚Ä‚ĚƒGƒrƒfƒ“ƒX‚͒Ⴂ‚ށCŘœŒă’f’[—zŤ—á‚É‚Í•úŽËü—Ă–@‚đl—ś‚ľ‚Ä‚ŕ—Ç‚˘‚Ş—Ő°Œ¤‹†‚Ć‚ľ‚čs‚¤‚Ě‚Ş–]‚Ü‚ľ‚˘Bˆę•űŽĄ–üŘœ—á‚ɑ΂ľ‚Ä‚Í‚ť‚Ě“K‰ž‚͐Td‚Ĺ‚Č‚Ż‚ę‚΂Ȃç‚Č‚˘B‚ą‚ę‚ç‚đ“Ľ‚Ü‚Ś‚Ä’_“šŠŕŘœ—á‚É‚¨‚Ż‚ép’†pŒă•úŽËü—Ă–@‚ĚˆÓ‹`‚ɂ‚˘‚Ä‚ÍěŹˆĎˆő‚É‚ć‚铢‹c‚Ĺ‚ŕˆÓŒŠ‚Ş•Ş‚Š‚ęC„§“x‚đ‚‚Ż‚é‚ą‚Ć‚ÉˆĎˆő‰ď‚Ć‚ľ‚č‡ˆÓ‚Ş“ž‚ç‚ę‚Č‚Š‚Á‚˝‚˝‚߁C–{CQ ‚͐„§“x‚Č‚ľ‚Ć‚ľ‚˝B

ŽQl•śŒŁ

1j Bonet Beltrá n M, Allal AS, Gich I, et al. Is adjuvant radiotherapy needed after curative resection of extrahepatic biliary tract cancers? A systematic with a meta-analysis of observational studies. Cancer Treat Rev 2012; 38: 111-9.

2j Shinohara ET, Mitra N, Guo M, Metz JM. Radiotherapy is associated with improved survival in adjuvant and palliative treatment of extrahepatic cholangiocarcinomas. Int J Radiat Oncol Biol Phys. 2009; 74: 1191-8.

3j Wang SJ, Fuller CD, Kim JS, et al. Prediction model for estimating the survival benefit of adjuvant radiotherapy for gallbladder cancer. J Clin Oncol. 26: 2112-7, 2008.

4j Todoroki T, Ohara K, Kawamoto T, Koike N, Yoshida S, Kashiwagi H, Otsuka M, Fukao K. Benefits of adjuvant radiotherapy after radical resection of locally advanced main hepatic duct carcinoma. Int J Radiat Oncol Biol Phys. 2000; 46: 581-7.

5j Nakano K, Chijiiwa K, Toyonaga T, Ueda J, Takamatsu Y, Kimura M, Nakamura K, Yamaguchi K, Tanaka M. Combination therapy of resection and intraoperative radiation for patients with carcinomas of extrahepatic bile duct and ampulla of Vater: prognostic advantage over resection alone? Hepatogastroenterology. 2003; 50: 928-33.


ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ41
’_“šŠŕ‚ɑ΂ˇ‚鉝Šw•úŽËü—Ă–@‚ĚˆÓ‹`‚́H

”ńŘœ’_“šŠŕ‚̉ťŠw•úŽËü—Ă–@‚Í—Ő°Œ¤‹†‚Ć‚ľ‚čs‚¤‚Ě‚Ş–]‚Ü‚ľ‚˘B
’_“šŠŕŘœŒăA’f’[—zŤ—á‚ł͉ťŠw•úŽËü—Ă–@‚đs‚¤‚ą‚Ć‚đl—ś‚ľ‚Ä‚ŕ—Ç‚˘‚Ş—Ő°Œ¤‹†‚Ć‚ľ‚čs‚¤‚Ě‚Ş–]‚Ü‚ľ‚˘B

„§“x‚Č‚ľ

‰đŕ

‹ß”NWŠwŽĄ—Ă‚ĚˆęŠÂ‚Ć‚ľ‚ĉťŠw—Ă–@‚É‚ć‚é•úŽËü‘Š´Œř‰ĘEĆŽË–ěˆČŠO‚Ě“]ˆÚ—}§A“]ˆÚ•a‘ƒ‚̐§Œä‚đ–Ú“I‚Ć‚ľ‚ĉťŠw•úŽËü—Ă–@‚ލs‚í‚ę‚éBŘœ•s”\’_“šŠŕ‚ɑ΂ľ‚ẲťŠw•úŽËüŽĄ—Ă‚Ě—LŒřŤ•ń‚Í‘˝‚˘‚Ş1-5jA—L—pŤ‚đ”F‚ß‚Č‚Š‚Á‚˝•ń‚ŕ‚ ‚é6jB‹ß”NƒQƒ€ƒVƒ^ƒrƒ“‚âS-1 ‚ȂǐV‹K–ňÜ‚đ—p‚˘‚˝‰ťŠw•úŽËüŽĄ—Ă‚Ě•ń‚Ş‘‚Ś‚Ä‚Ť‚Ä‚˘‚é7, 8jBŠT‚ľ‚ĉťŠw•úŽËü—Ă–@‚Ĺ‚ÍMST‚Ş1 ”NˆČă‚Ě•ń‚Ş‘˝‚­Šú‘Ň‚ł‚ę‚é‚Ş2-5jAƒtƒb‰ťƒsƒŠƒ~ƒWƒ“Œn–ňÜˆČŠO‚Ě–ňÜ‚Ĺ‚Í•š—p‚Ěƒ^ƒCƒ~ƒ“ƒOi“ŻŽž•š—p‚ŠŒđŒÝ‚Š“™j7, 8j‚â•úŽËüŽĄ—Ă–@‚Ě“ŕ—eA–ňÜ—Ę‚Č‚Ç•W€“IƒŒƒWƒƒ“‚Í‚Č‚­Œ¤‹†’iŠK‚Ĺ‚ ‚éB

Řœ‰Â”\—á‚Ĺ‚ ‚Á‚Ä‚ŕÄ”­—\–h‚ɏpŒă‰ťŠw—Ă–@‚ލl—ś‚ł‚ęAŘœ’f’[—zŤ—á‚⃊ƒ“ƒpß“]ˆÚ‚đ—L‚ˇ‚éÇ—á‚ÉŠÖ‚ľ‚ẮCƒtƒb‰ťƒsƒŠƒ~ƒWƒ“Œn–ňÜ•š—p‚̏pŒă‰ťŠw•úŽËüŽĄ—Ă‚¨‚ć‚Ńˆř‚Ť‘ą‚­‰ťŠw—Ă–@‚ŕl—ś‚ł‚ę‚éB–T“ű“Ş•”Šŕ‚Ĺ‚Ě‘OŒü‚ŤŽŽŒą‚Ě•ń‚Ş‚ ‚é‚ŞA‚ť‚ĚŒ‹‰Ę‚͈ę’č‚ľ‚Ä‚˘‚Č‚˘9, 10jBpŒă•â•—Ă–@‘S”Ę‚Ěƒƒ^ƒAƒiƒŠƒVƒX/ƒVƒXƒeƒ~ƒbƒNƒŒƒrƒ…[‚ł́A“Á‚É’f’[—zŤ—á‚⃊ƒ“ƒpß—zŤŒQ‚Ĺ•â•—Ă–@‚Ş—L—p‚Ć‚Ě•ń‚Ş‚ ‚č11jA‚ť‚Ě’†‚Ĺ‚ŕ‰ťŠw—Ă–@‚≝Šw•úŽËü—Ă–@‚Ş•úŽËü—Ă–@’P“Ć‚ć‚č—ǍD‚ČŒXŒü‚đŽŚ‚ľ‚˝Bˆę”Ę“I‚ɂ͏pŒă‰ťŠw•úŽËüŽĄ—Ă‚Í’f’[—zŤ—á‚âT2 ˆČăAƒŠƒ“ƒpß—zŤ—á‚Ȃǐis—á‚Ĺ—L—p‚Ć‚ˇ‚é•ń‚Ş‘˝‚˘B‚Ü‚˝A‹ÇŠ§Œä—ŚŒüă‚Ě‚˝‚ߏp‘O‰ťŠw•úŽËü—Ă–@‚ŕŒ¤‹†‚Ć‚ľ‚ÄŽŽ‚Ý‚ç‚ę‚Ä‚˘‚é12, 13jB

ˆČă‚̂悤‚É’_“šŠŕ‚ɑ΂ˇ‚é•úŽËü—Ă–@‚ƉťŠw—Ă–@‚Ě•š—p‚Í—LŒř‚Ć‚Ě•ń‚Ş‘˝‚˘‚ŞŒ¤‹†’†‚Ě—Ěˆć‚Ĺ‚ ‚éBĄŒăC‘OŒü‚Ť—Տ°ŽŽŒą‚Ě’~Ď‚É‚ć‚Á‚āC’_“šŠŕ‚ɑ΂ˇ‚é•úŽËü—Ă–@‚ƉťŠw—Ă–@‚Ć‚Ě•š—p—Ă–@‚ސś‘śŠúŠÔi—Śj‚âQOL ‚ĚŒüă‚ÉŠń—^‚ˇ‚é‚Š”Ű‚Š‚đ–ž‚ç‚Š‚É‚ľ‚Ä‚˘‚­•K—v‚Ş‚ ‚éB‚ą‚ę‚ç‚đ“Ľ‚Ü‚Ś‚Ä’_“šŠŕ‚É‚¨‚Ż‚鉝Šw•úŽËü—Ă–@‚ĚˆÓ‹`‚ɂ‚˘‚Ä‚ÍěŹˆĎˆő‚É‚ć‚铢‹c‚Ĺ‚ŕˆÓŒŠ‚Ş•Ş‚Š‚ęC„§“x‚đ‚‚Ż‚é‚ą‚Ć‚ÉˆĎˆő‰ď‚Ć‚ľ‚č‡ˆÓ‚Ş“ž‚ç‚ę‚Č‚Š‚Á‚˝‚˝‚߁C–{CQ ‚͐„§“x‚Č‚ľ‚Ć‚ľ‚˝B

ŽQl•śŒŁ

1j Foo ML, Gunderson LL, Bender CE, Buskirk SJ. External radiation therapy and transcatheter iridium in the treatment of extrahepatic bile duct carcinoma. Int J Radiat Oncol Biol Phys. 1997; 39: 929-35.

2j Brunner TB, Schwab D, Meyer T, Sauer R. Chemoradiation may prolong survival of patients with non-bulky unresectable extrahepatic biliary carcinoma. A retrospective analysis. Strahlenther Onkol. 2004; 180: 751-7.

3j Alden ME, Mohiuddin M. The impact of radiation dose in combined external beam and intraluminal Ir-192 brachytherapy for bile duct cancer. Int J Radiat Oncol Biol Phys. 1994; 28: 945-51.

4j Leong E, Chen WW, Ng E, Van Hazel G, Mitchell A, Spry N. J Outcomes from combined chemoradiotherapy in unresectable and locally advanced resected cholangiocarcinoma. Gastrointest Cancer. 2012 Mar; 43: 50-5.

5j Akita H, Yamada T, Sasaki Y, Eguchi H, Ohigashi H, Ishikawa O, Imaoka S.@The evaluation of chemoradiotherapy to unresectable hepatobiliary cancers. Gan To Kagaku Ryoho. 2005 Oct; 32: 1727-9. Japanese.

6j Crane CH, Macdonald KO, Vauthey JN, Yehuda P, Brown T, Curley S, Wong A, Delclos M, Charnsangavej C, Janjan NA. Limitations of conventional doses of chemoradiation for unresectable biliary cancer. Int J Radiat Oncol Biol Phys. 2002; 53: 969-74.

7j Lin LL, Picus J, Drebin JA, Linehan DC, Solis J, Strasberg SM, Tan B, Thorstad WL, Myerson R. A phase Ⅱ study of alternating cycles of split course radiation therapy and gemcitabine chemotherapy for inoperable pancreatic or biliary tract carcinoma. Am J Clin Oncol. 2005; 28: 234-41.

8j Park JY, Park SW, Chung JB, Seong J, Kim KS, Lee WJ, Song SY. Concurrent chemoradiotherapy with doxifluridine and paclitaxel for extrahepatic bile duct cancer. Am J Clin Oncol. 2006; 29: 240-5.

9j Smeenk HG, van Eijck CH, Hop WC, Erdmann J, Tran KC, Debois M, van Cutsem E, van Dekken H, Klinkenbijl JH, Jeekel J. Long-term survival and metastatic pattern of pancreatic and periampullary cancer after adjuvant chemoradiation or observation: long-term results of EORTC trial 40891. Ann Surg. 2007; 246: 734-40.

10j Morak MJ, van der Gaast A, Incrocci L, van Dekken H, Hermans JJ, Jeekel J, Hop WC, Kazemier G, van Eijck CH.@djuvant intra-arterial chemotherapy and radiotherapy versus surgery alone in resectable pancreatic and periampullary cancer: a prospective randomized controlled trial. Ann Surg. 2008; 248: 1031-41.

11j Horgan AM, Amir E, Walter T, Knox JJ. Adjuvant therapy in the treatment of biliary tract cancer: a systematic review and meta-analysis. J Clin Oncol. 2012 Jun 1; 30: 1934-40.

12j McMasters KM, Tuttle TM, Leach SD, Rich T, Cleary KR, Evans DB, Curley SA.@Neoadjuvant chemoradiation for extrahepatic cholangiocarcinoma. Am J Surg. 1997; 174: 605-8; discussion 608-9.

13j Rea DJ, Heimbach JK, Rosen CB, Haddock MG, Alberts SR, Kremers WK, Gores GJ, Nagorney DM. Liver transplantation with neoadjuvant chemoradiation is more effective than resection for hilar cholangiocarcinoma. Ann Surg. 2005; 242: 451-8; discussion 458-61.


ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ42
’_ŠÇŠŕ‚ĚŽĄ—Ă‚Ć‚ľ‚āAphotodynamic therapy ‚͐„§‚ł‚ę‚é‚ŠH

Řœ•s”\’_ŠÇŠŕ‚ĚŽĄ—Ă‚Ć‚ľ‚āAphotodynamic therapy ‚Ě—L—pŤ‚đŽxŽ‚ˇ‚é•ń‚Ş‹ß”N‚Ý‚ç‚ęAs‚¤‚ą‚Ć‚đl—ś‚ľ‚Ä‚ŕ‚悢B

„§“x‚Č‚ľ

‰đŕ

Œőü—ÍŠw“IŽĄ—Ă; photodynamic therapyiPDTj‚́AŒőŠ´ŽóŤ•¨Žż‚ĆƒŒ[ƒU[ĆŽË‚É‚ć‚鎥—Ă–@‚ŁA’_ŠÇŠŕ‚ɑ΂ľ‚Ä‚ÍŒťÝ‚Ě‚Ć‚ą‚ë•ŰŒŻ“K‰ž‚É‚Č‚Á‚Ä‚˘‚Č‚˘1jB’_“šƒXƒeƒ“ƒg•š—pPDT ‚Ć’_“šƒXƒeƒ“ƒg’P“Ć‚đ”äŠr‚ˇ‚é‘OŒü‚ŤŽŽŒą ‚Ş2 •Ň•ń‚ł‚ę‚Ä‚˘‚é2, 3jB‚˘‚¸‚ę‚ŕŹ‹K–Í‚ĚŽŽŒą‚Ĺ‚ ‚é‚ŞAPDT ‚É‚ć‚鐜‘śŠúŠÔ‚̉„’ˇ‚đ•ń‚ľ‚Ä‚˘‚éBƒVƒXƒeƒ}ƒeƒBƒbƒNƒŒƒrƒ†[‚Ĺ‚ŕPDT ‚đ‰Á‚Ś‚é‚ą‚Ć‚É‚ć‚čƒXƒeƒ“ƒg’P“Ƃɔ䂾‚Đś‘ś—Ś‚đ‰ü‘P‚ˇ‚é‰Â”\Ť‚Ş‚ ‚é‚Ć‚Ě•ń‚Ş‚ ‚é4jB

ŒőŠ´ŽóŤ•¨Žż‚É‚ć‚éŒőü‰ß•qÇ‚ŕ‘ć‚Q˘‘ăŒőŠ´ŽóŤ•¨ŽżiƒŒƒUƒtƒBƒŠƒ“‚Ȃǁj‚̏oŒť‚É‚ć‚čŒyŒ¸‚ľ‚Ä‚Ť‚˝BˆČă‚ĚŒ‹‰Ę‚Š‚çCÇ—ᐔ‚ޏ­‚Č‚­C‚Ü‚˝s‚Ś‚éŽ{Ý‚ŕŒŔ‚ç‚ę‚Ä‚¨‚č‹­‚­„§‚Ĺ‚Ť‚郌ƒxƒ‹‚Ĺ‚Í‚Č‚˘‚ށA’_“šƒXƒeƒ“ƒg•š—pPDT‚́Cś‘śŠúŠÔ‚̉„’ˇ‚âQOL ‚ĚŒüă‚Ş”F‚ß‚ç‚ę‚é‚˝‚߁As‚¤‚ą‚Ć‚đl—ś‚ľ‚Ä‚ŕ‚悢BĄŒă‰ťŠw—Ă–@‚Ć‚Ě”äŠrŒ¤‹†‚ލs‚í‚ęPDT ‚Ě—Ő°“IˆÓ‹`‚Ş–ž‚ç‚Š‚É‚Č‚é‚ą‚Ć‚ŞŠú‘Ň‚ł‚ę‚éB‚ą‚ę‚ç‚đ“Ľ‚Ü‚Ś‚Ä’_“šŠŕŽĄ—Ă‚É‚¨‚Ż‚éPDT ‚ĚˆÓ‹`‚ɂ‚˘‚Ä‚ÍěŹˆĎˆő‚É‚ć‚铢‹c‚Ĺ‚ŕˆÓŒŠ‚Ş•Ş‚Š‚ęC„§“x‚đ‚‚Ż‚é‚ą‚Ć‚ÉˆĎˆő‰ď‚Ć‚ľ‚č‡ˆÓ‚Ş“ž‚ç‚ę‚Č‚Š‚Á‚˝‚˝‚߁C–{CQ ‚͐„§“x‚Č‚ľ‚Ć‚ľ‚˝B

ŽQl•śŒŁ

1j Nanashima A, Yamaguchi H, Shibasaki S, Ide N, Sawai T, Tsuji T, Hidaka S, Sumida Y, Nakagoe T, Nagayasu T Adjuvant photodynamic therapy for bile duct carcinoma after surgery: a preliminary study. J Gastroenterol. 2004; 39: 1095-101.

2j Ortner ME, Caca K, Berr F, Liebetruth J, Mansmann U, Huster D, Voderholzer W, Schachschal G, Mössner J, Lochs H. Successful photodynamic therapy for nonresectable cholangiocarcinoma: a randomized prospective study. Gastroenterology. 2003; 125: 1355-63.

3j Zoepf T, Jakobs R, Arnold JC, Apel D, Riemann JF. Palliation of nonresectable bile duct cancer: improved survival after photodynamic therapy. Am J Gastroenterol. 2005; 100: 2426-30.

4j Fayter D, Corbett M, Heirs M, Fox D, Eastwood A. A systematic review of photodynamic therapy in the treatment of pre-cancerous skin conditions, Barrett's oesophagus and cancers of the biliary tract, brain, head and neck, lung, oesophagus and skin. Health Technol Assess. 2010; 14: 1-288.


•a—

ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ43
’_“š‚É‚¨‚Ż‚é‘OŠŕE‘ŠúŠŕ•a•Ď‚ɂ͂ǂ̂悤‚Č‚ŕ‚Ě‚Ş‚ ‚é‚ŠH

Biliary intraepithelial neoplasiaiBilINj‚Ć’_ŠÇ“ŕ“ű“ޏóŽîᇁiIPNBj‚Í’_ŠÇŠŕ‚Ě‘OŠŕ•a•Ď‚Ĺ‚ ‚éB
’_囊”S–Œă”çƒfƒBƒXƒvƒ‰ƒWƒA‚Í’_囊Šŕ‚Ě‘OŠŕ•a•Ď‚Ĺ‚ ‚éB
\“ńŽw’°“ű“Ş•”‘BŽî‚͏\“ńŽw’°“ű“Ş•”Šŕ‚Ě‘OŠŕ•a•Ď‚Ĺ‚ ‚éB

„§“x‚Č‚ľ

‰đŕ
1j’_ŠÇŠŕ‚Ě‘OŠŕ•a•Ď

‘ĺŒ^ŠĚ“ŕ’_ŠÇ‚âŠĚŠO’_ŠÇ‚É‚¨‚Ż‚é‘OŠŕ•a•Ď‚Ć‚ľ‚ÄBilINibiliary intraepithelial neoplasiajA’_ŠÇ“ŕ“ű“ޏóŽîá‡; IPNBA’_ŠÇ”S‰t”X–EŤŽîá‡; MCNimucinous cystic neoplasmj‚Ş’ńĽ‚ł‚ę‚Ä‚˘‚éB

BilIN ‚́AŠĚ“ŕŒ‹ÎÇ‚⌴”­Ťd‰ťŤ’_ŠÇ‰Š‚Ć‚˘‚Á‚˝–Ť’_“šŽžŠł‚đŠî‘bŽžŠł‚Ć‚ľ‚Ä”­ś‚ľ‚˝’_ŠÇŠŕŽüˆÍ‚ɍ‚•p“x‚É‚Ý‚ç‚ę‚é‚ą‚Ć‚Ş•ń‚ł‚ę‚Ä‚˘‚éă”ç“ŕˆŮŒ^•a•Ď‚Ě‘Ě‚Ĺ1, 2jA•ŞŽqś•¨Šw“I‚É‚ŕ×–EŽüŠú’`”’icyclin D1, p21 ‚Ȃǁj‚Ě”­Œť‚âˆâ“`ŽqˆŮíiTP53, CDKN2A ‚Ȃǁj‚ŞŒy“xˆŮŒ`Źă”ç‚Š‚獂“xˆŮŒ^Ťă”çCŠŕ‚É‚Č‚é‚ɂ‚ę‚Ä‹­‚­‚Č‚é‚ą‚Ć‚Ş•ń‚ł‚ę‚Ä‚˘‚é3-5jB

’_ŠÇ“ŕ“ű“ޏóŽîᇂÍäX‚É‚¨‚Ż‚éäXŠÇ“ŕ“ű“Ş”S‰tŤŽîᇂɑΉž‚ˇ‚é•a‘ԂŁA‘BŽîA‹ŤŠEˆŤŤŽîᇁAă”ç“ŕŠŕ‚É•Ş—Ţ‚ł‚ę‚éBBilIN “Ż—lA×–EŽüŠú’`”’‚Ě”­Œť‚âˆâ“`Žq•ĎˆŮ‚ޗǐŤ•a•Ď‚Š‚ç’iŠK“I‚É”F‚ß‚ç‚ę3, 4jA‘BŽîA‹ŤŠEˆŤŤŽîᇂ͑OŠŕ•a•Ď‚ƍl‚Ś‚ç‚ę‚é‚ŞA•Ş—ޏă‚Ě–â‘č“_‚ŕŽw“E‚ł‚ę‚Ä‚˘‚éB

2j’_囊Šŕ‚Ě‘OŠŕ•a•Ď

Z’_囊ŠŕŽüˆÍ‚Ě”S–Œ‚ɂ́Aă”ç“ŕŠŕ‚Ć‚Ć‚ŕ‚ɃfƒBƒXƒvƒ‰ƒWƒA‚≝śŤă”çi—H–ĺ‘B‰ťśA’°ă”牝śjA‰ßŒ`ŹŤă”ç‚Ş33.4`81.6“‚Ě•p“x‚Ĺ”F‚ß‚ç‚ę‚é‚Ć•ń‚ł‚ę‚Ä‚˘‚é6, 7jB‚Č‚Š‚Ĺ‚ŕƒfƒBƒXƒvƒ‰ƒWƒA‚Í’_ÎÇA–Ť’_”X‰Š‚Ő؏œ‚ł‚ę‚˝’_”X“ŕ‚É‚Í0.4`33.8“‚Ě•p“x‚Ĺ‚ľ‚ŠŠĎŽ@‚ł‚ꂸ7-9jA‘OŠŕ•a•Ď‚Ĺ‚ ‚é‚ą‚Ć‚ŞŽŚ´‚ł‚ę‚éB‚Ü‚˝AƒfƒBƒXƒvƒ‰ƒWƒA‚ƉťśŤă”çA“Á‚É’°ă”牝ś‚Ć‚ĚŠÖ˜AŤ‚ŕŽw“E‚ł‚ę10-12jA•ŞŽqś•¨Šw“I‚ČŒŸ“˘13, 14j‚Š‚ç‚ŕ‰ťśă”灨ƒfƒBƒXƒvƒ‰ƒWƒA¨ă”ç“ŕŠŕ‚Ć‚˘‚¤sequence ‚ލl‚Ś‚ç‚ę‚Ä‚˘‚éB

3j\“ńŽw’°“ű“Ş•”Šŕ‚Ě‘OŠŕ•a•Ď@iCQ1ŽQĆj

\“ńŽw’°“ű“Ş•”Šŕ‚Ě”­Šŕ‰ß’ö‚É‚¨‚˘‚ẮAadenoma-carcinoma sequence ‚Ě‘śÝ‚Ş‹^‚í‚ę‚Ä‚¨‚čA\“ńŽw’°“ű“Ş•”‘BŽî‚Í‘OŠŕ•a•Ď‚ƍl‚Ś‚ç‚ę‚Ä‚˘‚éBŠŕ•a‘ƒŽü•Ó‚É‚Í42`91“‚ĚÇ—á‚Ĺ‘BŽî•a•Ď‚ލŹÝ‚ľ‚Ä‚¨‚č15-17jAŠŕ•a‘ƒ‚ސis‚ˇ‚é‚ɂ‚ę‚Ä‘BŽî•a•Ď‚͏­‚Č‚­‚Č‚čA‚Ü‚˝‘BŽî‚Š‚çŠŕ‚Ö‚ĚˆÚs‚ŕŠĎŽ@‚ł‚ę‚é‚Ć•ń‚ł‚ę‚Ä‚˘‚é15jB•ŞŽqś•¨Šw“I‚É‚ŕ Šŕˆâ“`ŽqiŽĺ‚ÉK-rasj‚âŠŕ—}§ˆâ“`ŽqiŽĺ‚Ép53j‚ĚˆŮí‚ŞA“Á‚ÉŠŕ•a‘ƒŽüˆÍ‚Ě‘BŽî•a•Ď‚É‚Í‚ˇ‚Ĺ‚É‹N‚ą‚Á‚Ä‚˘‚é‚Ć•ń‚ł‚ę‚Ä‚˘‚é17, 18jB

ŽQl•śŒŁ

1j Zen Y, Sasaki M, Fujii T, Chen TC, Chen MF, Yeh TS, Jan YY, Huang SF, Nimura Y, Nakanuma Y. Different expression patterns of mucin core proteins and cytokeratins during intrahepatic cholangiocarcinogenesis from biliary intraepithelial neoplasia and intraductal papillary neoplasm of the bile duct--an immunohistochemical study of 110 cases of hepatolithiasis. J Hepatol 2006; 44: 350-358.

2j Lewis JT, Talwalkar JA, Rosen CB, Smyrk TC, Abraham SC. Precancerous bile duct pathology in end-stage primary sclerosing cholangitis,with and without cholangiocarcinoma. Am J Surg Pathol 2010; 34: 27-34.

3j Nakanishi Y, Zen Y, Kondo S, Itoh T, Itatsu K, Nakanuma Y. Expression of cell cycle-related molecules in biliary premalignant lesions: biliary intraepithelial neoplasia and biliary intraductal papillary neoplasm. Hum Pathol 2008; 39: 1153-1161.

4j Itatsu K, Zen Y, Ohira S, Ishikawa A, Sato Y, Harada K, Ikeda H, Sasaki M, Nimura Y, Nakanuma Y. Immunohistochemical analysis of the progression of flat and papillary preneoplastic lesions in intrahepatic cholangiocarcinogenesis in hepatolithiasis. Liver Int 2007; 27: 1174-1184.

5j Rougemont AL, Genevay M, McKee TA, Gremaud M, Mentha G, Rubbia-Brandt L. Extensive biliary intraepithelial neoplasia (BilIN) and multifocal early intrahepatic cholangiocarcinoma in non-biliary cirrhosis. Virchows Arch 2010; 456: 711-717.

6j Roa I, de Aretxabala X, Araya JC, Roa J. Preneoplastic lesions in gallbladder cancer. J Surg Oncol 2006; 93: 615-623.

7j Stancu M, Căruntu ID, Giuşcă S, Dobrescu G. Hyperplasia, metaplasia, dysplasia and neoplasia lesions in chronic cholecystitis-a morphologic study. Rom J Morphol Embryol 2007; 48: 335-342.

8j Duarte I, Llanos O, Domke H, Harz C, Valdivieso V. Metaplasia and precursor lesions of gallbladder carcinoma. Frequency, distribution, and probability of detection in routine histologic samples. Cancer 1993; 72: 1878-1884.

9j Laitio M. Histogenesis of epithelial neoplasms of human gallbladder I. Dysplasia. Pathol Res Pract 1983; 178: 51-56.

10j Duarte I, Llanos O, Domke H, Harz C, Valdivieso V. Metaplasia and precursor lesions of gallbladder carcinoma. Frequency, distribution, and probability of detection in routine histologic samples. Cancer 1993; 72: 1878-1884.

11j Inada A, Konishi F, Yamamichi N, Ito H. Histogenesis of gallbladder cancer with special reference to metaplastic changes and distribution of various mucins and CEA. Nihon Geka Gakkai Zasshi 1989; 90: 894-906.

12j Yamagiwa H, Tomiyama H. Intestinal metaplasia-dysplasia-carcinoma sequence of the gallbladder. Acta Pathol Jpn 1986; 36: 989-997.

13j Roa JC, Roa I, Correa P, Vo Q, Araya JC, Villaseca M, Guzmán P, Schneider BG. Microsatellite instability in preneoplastic and neoplastic lesions of the gallbladder. J Gastroenterol 2005; 40: 79-86.

14j García P, Manterola C, Araya JC, Villaseca M, Guzmán P, Sanhueza A, Thomas M, Alvarez H, Roa JC. Promoter methylation profile in preneoplastic and neoplastic gallbladder lesions. Mol Carcinog. 2009; 48: 79-89.

15j Kaiser A, Jurowich C, Schönekäs H, Gebhardt C, Wünsch PH. The adenoma-carcinoma sequence applies to epithelial tumours of the papilla of Vater. Z Gastroenterol 2002; 40: 913-920.

16j Baczako K, Büchler M, Beger HG, Kirkpatrick CJ, Haferkamp O. Morphogenesis and possible precursor lesions of invasive carcinoma of the papilla of Vater: epithelial dysplasia and adenoma. Hum Pathol 1985; 16: 305-310.

17j Takashima M, Ueki T, Nagai E, Yao T, Yamaguchi K, Tanaka M, Tsuneyoshi M. Carcinoma of the ampulla of Vater associated with or without adenoma: a clinicopathologic analysis of 198 immunohistochemical expressions. Mod Pathol 2000; 13: 1300-1307.

18j Howe JR, Klimstra DS, Cordon-Cardo C, Paty PB, Park PY, Brennan MF. K-ras mutation in adenoma and carcinomas of the ampulla of Vater. Clin Cancer Res 1997; 3: 129-133.


ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


CQ44
’_“š‚É‚¨‚Ż‚éŽîᇗގ—•a•Ď‚ɂ͂ǂ̂悤‚Č‚ŕ‚Ě‚Ş‚ ‚é‚ŠB

’_“š‚É‚¨‚Ż‚éŽîᇗގ—•a•Ď‚ɂ́AiAjd‰ťŤ’_ŠÇ‰Ši’_ŠÇŠŕ‚Ƃ̊ӕʁjAiBj‰ŠF“÷‰čŽîŤ’_”X‰ŠAiCj’_”X‘B‹ŘŽîÇi’_”XŠŕ‚Ƃ̊ӕʁj‚Č‚Ç‚Ş‚ ‚°‚ç‚ę‚éB

„§“x‚Č‚ľ

‰đŕ
A.d‰ťŤ’_ŠÇ‰Šsclerosing cholangitis

ŠĚŠO’_ŠÇAŠĚ“ŕ’_ŠÇA‚Ü‚˝‚Í‚ť‚Ě—źŽŇ‚Ě’_ŠÇ•Ç‚Ć‚ť‚ĚŽüˆÍ‚ɍ‚“x‚̐üˆŰ‰ť‚Ć–Ť‰ŠÇ‚Ş‚Ý‚ç‚ęAŒŔ‹ÇŤ‚Č‚˘‚ľ‚Ń‚Ü‚ńŤ‚Ě’_ŠÇ‹ˇó‚â•ÂÇAŠg’Ł‚đ‚Ť‚˝‚ˇ•a‘Ô‚Ĺ‚ ‚čA’_ŠÇŠŕ‚Ć‚ĚŠÓ•Ę‚Şd—v‚Ĺ‚ ‚éBŒ´”­ŤAIgG4 ŠÖ˜AA‚ť‚ę‚ÉŒ´ˆö‚Ş–ž‚ç‚Š‚Č‘ą”­Ťi“ńŽŸŤjd‰ťŤ’_ŠÇ‰Š‚É•Ş—Ţ‚ł‚ę‚éB

  1. 1jŒ´”­Ťd‰ťŤ’_ŠÇ‰Š; PSCiprimary sclerosing cholangitisj ‚́AŒ´ˆö•s–ž‚̐isŤŽžŠł‚ŁA•a‰Šú‚Í–łÇó‚ĚÇ—á‚Ş‘˝‚˘‚Ş1jA’_ŠÇ‚Ě‹ˇó‚âŠg’Ł‚É”ş‚˘’_`‚¤‚Á‘؁C‰Šát‚â’_ŠÇ‰Š‚ޏoŒť‚ľAŠĚüˆŰ‰ť‚ސi“W‚ľAŠĚd•ĎAŠĚ‹@”\•s‘S‚ւƐis‚ˇ‚éB‰ä‚ލ‘‚Ĺ‚Í20 Ë‘ă‚Ć50`60 Ë‘ă‚É‚Q•ôŤ‚Ěƒs[ƒN‚Ş‚Ý‚ç‚ęAŽá”N”­Ç—á‚Ĺ‚Í’×ᇐŤ‘ĺ’°‰Š‚̍‡•š—Ś‚ލ‚‚˘Bis—á‚ł́A’_ŠÇŠŕ‚đ‡•š‚ˇ‚é—á‚Ş‚ ‚éi3.6“‚ɍ‡•šj2jBPSC ‚Ě•a—ŠŒŠ‚́AŠĚ“ŕŠO’_ŠÇ‚̐üˆŰ‰ť‚ƁA’_ŠÇ‚Ě‹ˇŹ‰ťEÁŽ¸‚Č‚ç‚Ń‚ÉŠg’Ł‚đ“Á’Ľ‚Ć‚ˇ‚éB
  2. 2jIgG4 ŠÖ˜Ad‰ťŤ’_ŠÇ‰Š; IgG4-related sclerosing cholangitisiIgG4-SCj‚Ƃ́AŒŒ’†IgG4 ’l‚̏㏸A•a•Ď‹ÇŠ‚̐üˆŰ‰ť‚ĆƒŠƒ“ƒp‹…CŒ`Žż×–E‚Ě’˜‚ľ‚˘Z‚Č‚Ç‚đ“Á’Ľ‚Ć‚ˇ‚é3, 4jB‹ˇó•”ˆĘ‚Ĺ‚Í‘SŽüŤ‚Ě’_ŠÇ•Ç‚Ě”ěŒú‚đ”F‚߁A‹ˇó‚đ”F‚ß‚Č‚˘•”ˆĘ‚É‚ŕ“Ż—l‚̕ωť‚Ş‚Ý‚ç‚ę‚é‚ą‚Ć‚Ş‘˝‚˘BŽŠŒČ–ƉuŤäX‰Š‚đ‹É‚߂č‚—Ś‚ɍ‡•š‚ˇ‚é5jB‚—î‚Ě’jŤ‚ɍD”­‚ľA•ÂÇŤ‰Šát‚Ĺ”­Ç‚ˇ‚é‚ą‚Ć‚Ş‘˝‚˘BƒXƒeƒƒCƒhŽĄ—Ă‚É‘tŒř‚ľ‚Ä—Ő°’ĽŒóA‰ć‘œŠŒŠ‚Ȃǂ̉ü‘P‚đ”F‚ß‚éBIgG4-SC ‚́A”äŠr“IV‚ľ‚˘ŽžŠłŠT”O‚Ĺ‚ ‚é‚˝‚߁A]—ˆAPSC ‚Ɛf’f‚ł‚ę‚Ä‚˘‚˝Ç—á‚Ě’†‚ɁA–{ŽžŠł‚ŞŠÜ‚Ü‚ę‚Ä‚˘‚é‰Â”\Ť‚ŕ‚ ‚éB IgG4-SC‚Ě•a—ŠŒŠ‚́A’_ŠÇ•Ç‚É–§‚ČƒŠƒ“ƒp‹…EŒ`Žż×–EZAüˆŰ‰ťA•ÂÇŤĂ–Ź‰Š‚ŞŒŠ‚ç‚ę‚éB–Ɖu‘gD‰ťŠw“I‚ɂ́A‘˝”‚ĚIgG4—zŤ×–E‚̐Z‚ŞŠm”F‚ł‚ę‚éB’_ŠÇ•ÇŒ‹‡D‚ɉŠÇ‚ĚŽĺŔ‚Ş‚ ‚čAă”ç‚͐łí‚Ĺ‚ ‚é‚ą‚Ć‚Ş‘˝‚˘6jB
B.‰ŠF“÷‰čŽîŤ’_”X‰Š; XGC ixanthogranulomatous cholecystitisj

XGC ‚́A’_ÎÇŠłŽŇ‚Ě1-2“‚É‚Ý‚ç‚ęA—Ť‚É‘˝‚˘B‹ŤŠE‚Ş•s–ž—ĂȉŠF‚ĚŒ‹ßŤ•a•Ď‚Ĺ‚ ‚čA”ěŒú‚ľ‚˝’_囊 •Ç‚ɘA‘ą‚ľA’°ŠÇ‚âŠĚ‚Č‚Ç‚ĚŽüˆÍ‘ŸŠí‚É•a•Ď‚Ş”g‹y‚ˇ‚é—á‚Ş‚ ‚čA’_”XŠŕ‚Č‚Ç‚ĚˆŤŤŽîá‡‚Ć‚ĚŠÓ•Ę‚Ş–â‘č‚Ć‚Č‚é7jB‘gDŠw“I‚ɂ́A–A–—×–E‚đŽĺ‘̂ɁA’P‹…AƒŠƒ“ƒp‹…AŒ`Žż×–EAD’†‹…‚Ȃǂ̉ŠÇ×–EZ‚ɉÁ‚Ś‚āAˆŮ•¨Œ^‹×–E‚Ć“÷‰č‘gD‚ĚŒ`Ź‚ލŹÝ‚ˇ‚é”äŠr“IŒŔ‹Ç‚ľ‚˝‰ŠÇ‘ƒ‚ć‚č‚Č‚éBRAiRokitansky-Aschoffj“´“ŕ‚É’™—Ż‚ľ‚˝’_`Ź•Ş‚Ş’_”X•Ç“ŕ‚ɘRo‚ľA‚ą‚ę‚ɑ΂ˇ‚éˆŮ•¨”˝‰ž‚É‚ć‚č“÷‰čŽîŤ‰ŠÇ‚ŞŒ`Ź‚ł‚ę‚éB—ŢŽ—‚Ě•a•Ď‚́A’_ŠÇ‚É‚ŕ”­ś‚ľA‰ŠF“÷‰čŽîŤ’_ŠÇ‰Š‚ĆŒÄ‚Î‚ę‚éB

C.’_”X‘B‹ŘŽîÇ adenomyomatosis

’_”X‘B‹ŘŽîÇ‚Í‘B‹Ř‰ßŒ`Źiadenomyomatous hyperplasiaj‚Ć‚ŕŒÄ‚΂ęARA “´‚Ć•˝ŠŠ‹ŘiüˆŰ‹Ř‘gDj‚Ě‘ś‚ŁA’_”X•Ç‚ŞŒŔ‹ÇŤ‚ŕ‚ľ‚­‚Í‚Ń‚Ü‚ńŤ‚É”ěŒú‚đ’悡‚é•a•Ď‚Ĺ‚ ‚éBŸ÷–Œ‰ş‘w‚É‚˘‚˝‚é’_”X•Ç‚Ş”ěŒú‚ˇ‚é‚˝‚߂ɁA—˛‹NŒ^‚Č‚˘‚ľ‚Ń‚Ü‚ńZŒ^‚Ě’_囊Šŕ‚Ć‚ĚŠÓ•Ę‚đ—v‚ˇ‚é—á‚Ş‚ ‚éB•a•Ď‚Ě•”ˆĘ‚âL‚Ş‚č‚Š‚çAŒŔ‹ÇŒ^A—֏óŒ^A‚Ń‚Ü‚ńŒ^‚É•Ş—Ţ‚ł‚ę‚é7jB

‘gDŠw“I‚ɁA’_”X‘B‹ŘŽîÇ‚ÍRA “´‚ŞŒĹ—L‹Ř‘w‚Š‚çŸ÷–Œ‰ş‘w‚É‚Š‚Ż‚Ä‘śEŠg’Ł‚ľA‚ť‚ę‚đŽć‚čˆÍ‚ނ悤‚É‚ľ‚Ä•˝ŠŠ‹ŘüˆŰ‚ĆäPŒ´üˆŰ‚Ş‘‰Á‚ˇ‚éB

D.\“ńŽw’°“ű“Ş•”‚Ĺ‚ĚŽîᇗގ—•a•Ď

“ű“Ş•”‰Š papillitisA“ű“Ş—Ěˆć‚Ě‘B‹ŘŤ‰ßŒ`Źadenomyomatous hyperplasia ‚Č‚Ç‚Ş‚ ‚éB

ŽQl•śŒŁ

1j Krones E, Graziadei I, Trauner M, Fickert P. Evolving concepts in primary sclerosing cholangitis. Liver Int. 2012 Mar; 32: 352-69.

2j Takikawa H, Manabe T.@Primary sclerosing cholangitis in Japan--analysis of 192 cases. J Gastroenterol. 1997 Feb; 32: 134-7.

3j Ohara H, Okazaki K, Tsubouchi H, Inui K, Kawa S, Kamisawa T, Tazuma S, Uchida K, Hirano K, Yoshida H, Nishino T, Ko SB, Mizuno N, Hamano H, Kanno A, Notohara K, Hasebe O, Nakazawa T, Nakanuma Y, Takikawa H.Clinical diagnostic criteria of IgG4-related sclerosing cholangitis 2012. J Hepatobiliary Pancreat Sci. 2012; 19: 536-42.

4j IgG4 ŠÖ˜Ad‰ťŤ’_ŠÇ‰Š—Տ°f’fŠî€ěŹƒ[ƒLƒ“ƒOƒOƒ‹[ƒv. ’_“š 26; 59-63,2012.

5j Zen Y, Harada K, Sasaki M, Sato Y, Tsuneyama K, Haratake J, Kurumaya H, Katayanagi K, Masuda S, Niwa H, Morimoto H, Miwa A, Uchiyama A, Portmann BC, Nakanuma Y. IgG4-related sclerosing cholangitis with and without hepatic inflammatory pseudotumor, and sclerosing pancreatitis-associated sclerosing cholangitis: do they belong to a spectrum of sclerosing pancreatitis? Am J Surg Pathol. 2004 Sep; 28: 1193-203.

6j Nakanuma Y, Zen Y, Portman BC. Diseases of the bile ducts. MacSweenfs Pathology of the Liver (Eds. Burt A, Portman BAFerrell L) Churchill Livingstone 6th ed.,Edinburg, London, New York, Oxford, Philadelphia, St Louis, Sydney, Toronto, 2011App.491- 562.

7j Albores-Saavedra J, Langeles-Angeles A Diseases of the gallbladder. MacSweenfs Pathology of the Liver (Eds. Burt A, Portman BAFerrell L) Churchill Livingstone 6th ed.,Edinburg, London, New York, Oxford, Philadelphia, St Louis, Sydney, Toronto, 2011App.563- 597.