堀口 祐爾¹, 大漉 正夫¹, 北野 徹¹, 田口 寛子¹, 今井 英夫¹, 伊藤 圓¹, 宮川 秀一², 中村 従之², 鄭 統圭²

Yuji HORIGUCHI¹, Masao OOSUKI¹, Tohru KITANO¹, Hiroko TAGUCHI¹, Hideo IMAI¹, Madoka ITOH¹, Syuichi MIYAKAWA², Yoriyuki NAKAMURA², Tokei TEI²

¹藤田学園保健衛生大学消化器内科, ²藤田学園保健衛生大学外科

¹Division of Gastroenterology, FujitaGakuen Health University School of Medicine, ²Department of Surgery, FujitaGakuen Health University School of Medicine

キーワード : Bile duct cancer, Ultrasonography, Tumor invasion, Tumor extension

　Ultrasonography (US) is the most useful modality not only for diagnosis of obstructive jaundice but also for detection of bile duct tumor. In this paper, we tried to clarify the ultrasonographic features of extrahepatic bile duct cancer and then evaluate preoperative predictability of the tumor extension in 37 cases, including 21 of the upper bile duct cancer and 13 of the middle bile duct cancer.
　The mass was demonstrated in 31 (83.8%), the echo level of that was hyperechoic in 17 cases (54.8%) and hypoechoic in 8 (25.8%). The mean size of hyperechoic mass was 2.8±1.5 cm, which was smaller than that of the hypoechoic mass (4.3±0.7 cm). But the echo level of the tumor was not correlative with the location or macroscopic findings.
　The tumor could be resected in 21 cases. We compared the sonogram with macroscopic findings of the resected specimen in 8 lesions which could be demonstrated clearly by US. In most of cases, serosal infiltration (S) and direct invasion to the liver (Hinf) could be evaluated from the sonographic findings such as disappearance or discontinuation of bile duct wall. But the evaluation of serosal and hepatic infiltration was failed in diffusely infiltrating type, and depth and spread of intramural invasion could not be assessed by US.
　From these results, US has facilitated to predict extramural extension of the tumor to some extent especially in nodular and papillary type cancer.