臨床外科64巻8号

2009年08月発行

特集 胆囊癌根治手術をめぐる諸問題

〔T2症例の根治手術〕

pT2胆囊癌の手術―R0 with D2で個別化した外科治療を

著者： 横溝博¹ 平田稔彦¹ 林亨治¹ 木村有¹ 中嶌雅之¹ 松田圭央¹ 木原康宏¹ 山永成美¹ 寺倉宏嗣¹ 山根隆明¹

所属機関： ¹熊本赤十字病院外科

ページ範囲：P.1049 - P.1056

文献概要

要旨：pT2胆囊癌は，原発巣は胆囊内に限局しつつもリンパ節転移を有することがあり，早期癌から進行癌への移行期にあたる．今のところこのpT2胆囊癌に対する外科治療に関して，予防的な肝切除や胆管切除の有効性を示すエビデンスはない．したがって手術にあたっては，肝切除や胆管切除はサージカルマージンを確保（R0を達成）するためのオプションと捉え，郭清は可能ならD2まで行うと考えると合理的な術式構築ができる．同じpT2胆囊癌でも病変の存在部位や患者の全身状態によりその病状は様々である．画一的な標準術式をすべての患者に適応するのは合理的ではなく，個々の患者に合わせたテーラーメイド外科治療を目指すべきである．

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