肝門部胆管癌と鑑別困難であった肝門部限局性非特異性慢性胆管炎の2手術例

肝門部胆管癌と診断し肝外胆管切除を伴う肝葉切除を施行した良性胆道狭窄の2例を報告する．いずれの症例も黄疸を主訴に他院にて胆道ドレナージを受けた後，来院した．右肝管を中心に著明な狭窄像を呈し，CTでは腹腔内リンパ節腫大が目立った．膵臓には異常所見を診断しえなかった．また，胆管像では進行性硬化性胆管炎に特徴的な所見を認めず臨床症状，画像検査所見からは良性疾患と診断しえなかった．いずれの症例も肝右葉切除，尾状葉切除，肝外胆管切除術を施行した．病理組織学的検討ではいずれも粘膜下に著明なlymphoplasmacytic inflammatory infiltrationを認める慢性胆管炎の所見でIgG...

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Published in日本消化器外科学会雑誌 Vol. 43; no. 2; pp. 160 - 165
Main Authors 伊神, 剛, 横山, 幸浩, 渡邊, 真哉, 江畑, 智希, 梛野, 正人, 西尾, 秀樹, 菅原, 元
Format Journal Article
LanguageJapanese
Published 一般社団法人 日本消化器外科学会 01.02.2010
Online AccessGet full text
ISSN0386-9768
1348-9372
DOI10.5833/jjgs.43.160

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Abstract 肝門部胆管癌と診断し肝外胆管切除を伴う肝葉切除を施行した良性胆道狭窄の2例を報告する．いずれの症例も黄疸を主訴に他院にて胆道ドレナージを受けた後，来院した．右肝管を中心に著明な狭窄像を呈し，CTでは腹腔内リンパ節腫大が目立った．膵臓には異常所見を診断しえなかった．また，胆管像では進行性硬化性胆管炎に特徴的な所見を認めず臨床症状，画像検査所見からは良性疾患と診断しえなかった．いずれの症例も肝右葉切除，尾状葉切除，肝外胆管切除術を施行した．病理組織学的検討ではいずれも粘膜下に著明なlymphoplasmacytic inflammatory infiltrationを認める慢性胆管炎の所見でIgG4免疫染色検査は陰性であった．肝門部胆管狭窄病変を診断する際には，本報告で示したような症例があることを常に念頭におき，慎重な対応を心がける必要がある．
AbstractList 肝門部胆管癌と診断し肝外胆管切除を伴う肝葉切除を施行した良性胆道狭窄の2例を報告する．いずれの症例も黄疸を主訴に他院にて胆道ドレナージを受けた後，来院した．右肝管を中心に著明な狭窄像を呈し，CTでは腹腔内リンパ節腫大が目立った．膵臓には異常所見を診断しえなかった．また，胆管像では進行性硬化性胆管炎に特徴的な所見を認めず臨床症状，画像検査所見からは良性疾患と診断しえなかった．いずれの症例も肝右葉切除，尾状葉切除，肝外胆管切除術を施行した．病理組織学的検討ではいずれも粘膜下に著明なlymphoplasmacytic inflammatory infiltrationを認める慢性胆管炎の所見でIgG4免疫染色検査は陰性であった．肝門部胆管狭窄病変を診断する際には，本報告で示したような症例があることを常に念頭におき，慎重な対応を心がける必要がある．
Author 横山, 幸浩
菅原, 元
梛野, 正人
西尾, 秀樹
伊神, 剛
江畑, 智希
渡邊, 真哉
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References 9) LaRusso NF, Shneider BL, Black D et al: Primary sclerosing cholangitis: summary of a workshop. Hepatology 44: 746-764, 2006
15) Are C, Gonen M, D'Angelica M et al: Differential diagnosis of proximal biliary obstruction. Surgery 140: 756-763, 2006
3) Choi JY, Kim MJ, Lee JM et al: Hilar cholangiocarcinoma: role of preoperative imaging with sonography, MDCT, MRI, and direct cholangiography. AJR Am J Roentgenol 191: 1448-1457, 2008
1) Endo I, Shimada H, Sugita M et al: Role of three-dimensional imaging in operative planning for hilar cholangiocarcinoma. Surgery 142: 666-675, 2007
6) Nimura Y: Staging cholangiocarcinoma by cholangioscopy. HPB (Oxford) 10: 113-115, 2008
8) Bagia JS, North L, Hunt DR: Mirizzi syndrome: an extra hazard for laparoscopic surgery. ANZ J Surg 71: 394-397, 2001
12) Krishna RP, Kumar A, Singh RK et al: Xanthogranulomatous inflammatory strictures of extrahepatic biliary tract: presentation and surgical management. J Gastrointest Surg 12: 836-841, 2008
16) Kamisawa T, Okamoto A: IgG4-related sclerosing disease. World J Gastroenterol 14: 3948-3955, 2008
4) Fujita N, Noda Y, Kobayashi G et al: Staging of bile duct carcinoma by EUS and IDUS. Endoscopy 30 (Suppl 1): A132-134, 1998
13) Corvera CU, Blumgart LH, Darvishian F et al: Clinical and pathologic features of proximal biliary strictures masquerading as hilar cholangiocarcinoma. J Am Coll Surg 201: 862-869, 2005
7) Charatcharoenwitthaya P, Enders FB, Halling KC et al: Utility of serum tumor markers, imaging, and biliary cytology for detecting cholangiocarcinoma in primary sclerosing cholangitis. Hepatology 48: 1106-1117, 2008
5) Inui K, Miyoshi H: Cholangiocarcinoma and intraductal sonography. Gastrointest Endosc Clin N Am 15: 143-155, 2005
14) Aoki T, Kubota K, Oka T et al: Follicular cholangitis: another cause of benign biliary stricture. Hepatogastroenterology 50: 639-642, 2003
10) Erdogan D, Kloek JJ, ten Kate FJ et al: Immunoglobulin G4-related sclerosing cholangitis in patients resected for presumed malignant bile duct strictures. Br J Surg 95: 727-734, 2008
11) Kawate S, Ohwada S, Ikota H et al: Xanthogranulomatous cholangitis causing obstructive jaundice: a case report. World J Gastroenterol 12: 4428-4430, 2006
17) Nishiyama Y, Yamamoto Y, Kimura N et al: Comparison of early and delayed FDG PET for evaluation of biliary stricture. Nucl Med Commun 28: 914-919, 2007
2) Sugiura T, Nishio H, Nagino M et al: Value of multidetector-row computed tomography in diagnosis of portal vein invasion by perihilar cholangiocarcinoma. World J Surg 32: 1478-1484, 2008
References_xml – reference: 15) Are C, Gonen M, D'Angelica M et al: Differential diagnosis of proximal biliary obstruction. Surgery 140: 756-763, 2006
– reference: 7) Charatcharoenwitthaya P, Enders FB, Halling KC et al: Utility of serum tumor markers, imaging, and biliary cytology for detecting cholangiocarcinoma in primary sclerosing cholangitis. Hepatology 48: 1106-1117, 2008
– reference: 10) Erdogan D, Kloek JJ, ten Kate FJ et al: Immunoglobulin G4-related sclerosing cholangitis in patients resected for presumed malignant bile duct strictures. Br J Surg 95: 727-734, 2008
– reference: 17) Nishiyama Y, Yamamoto Y, Kimura N et al: Comparison of early and delayed FDG PET for evaluation of biliary stricture. Nucl Med Commun 28: 914-919, 2007
– reference: 4) Fujita N, Noda Y, Kobayashi G et al: Staging of bile duct carcinoma by EUS and IDUS. Endoscopy 30 (Suppl 1): A132-134, 1998
– reference: 3) Choi JY, Kim MJ, Lee JM et al: Hilar cholangiocarcinoma: role of preoperative imaging with sonography, MDCT, MRI, and direct cholangiography. AJR Am J Roentgenol 191: 1448-1457, 2008
– reference: 16) Kamisawa T, Okamoto A: IgG4-related sclerosing disease. World J Gastroenterol 14: 3948-3955, 2008
– reference: 14) Aoki T, Kubota K, Oka T et al: Follicular cholangitis: another cause of benign biliary stricture. Hepatogastroenterology 50: 639-642, 2003
– reference: 6) Nimura Y: Staging cholangiocarcinoma by cholangioscopy. HPB (Oxford) 10: 113-115, 2008
– reference: 8) Bagia JS, North L, Hunt DR: Mirizzi syndrome: an extra hazard for laparoscopic surgery. ANZ J Surg 71: 394-397, 2001
– reference: 5) Inui K, Miyoshi H: Cholangiocarcinoma and intraductal sonography. Gastrointest Endosc Clin N Am 15: 143-155, 2005
– reference: 11) Kawate S, Ohwada S, Ikota H et al: Xanthogranulomatous cholangitis causing obstructive jaundice: a case report. World J Gastroenterol 12: 4428-4430, 2006
– reference: 9) LaRusso NF, Shneider BL, Black D et al: Primary sclerosing cholangitis: summary of a workshop. Hepatology 44: 746-764, 2006
– reference: 1) Endo I, Shimada H, Sugita M et al: Role of three-dimensional imaging in operative planning for hilar cholangiocarcinoma. Surgery 142: 666-675, 2007
– reference: 2) Sugiura T, Nishio H, Nagino M et al: Value of multidetector-row computed tomography in diagnosis of portal vein invasion by perihilar cholangiocarcinoma. World J Surg 32: 1478-1484, 2008
– reference: 13) Corvera CU, Blumgart LH, Darvishian F et al: Clinical and pathologic features of proximal biliary strictures masquerading as hilar cholangiocarcinoma. J Am Coll Surg 201: 862-869, 2005
– reference: 12) Krishna RP, Kumar A, Singh RK et al: Xanthogranulomatous inflammatory strictures of extrahepatic biliary tract: presentation and surgical management. J Gastrointest Surg 12: 836-841, 2008
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Title 肝門部胆管癌と鑑別困難であった肝門部限局性非特異性慢性胆管炎の2手術例
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