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담낭 및 간외담도의 악성종양

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 Malignant tumors of the gall bladder and the extrahepatic bile ducts 
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[한글] 원발성 담낭암과 간외담도암은 증상이나 이학적소견이 타담도질환에 비하여 특이한 것이 드물고, 증세가 나타났을때는 이미 진행된 상태여서 수술에 의한 완치율이 적고 5년생존율도 극히 저조하다. 간외담도암의 경우 성장이 늦고 임파계등으로의 원격전이도 늦게되어 악성종양이 진행될 경우 간기능부전증에 의하여 사망하는 경우도 흔하다. 따라서 수술로 근치수술은 어렵지만 담도배액술을 실시하여 2년이상 생존하는 경우가 많이 보고되고 있다. 1964년 1월 1일부터 1981년 12월 31일까지 만18년간 연세대학교 의과대학 외과학교실에서 수술로서 확진된 담낭의 악성종양 41예, Vater씨. 팽대부를 제외한 십이지장 상부의 간외담도암 72예를 비교분석하고 이에 대한 임상적 고찰을 하였다. 1) 담당암은 여자 22예, 남자 19예로 여자에 많았으며, 간외담도암은 여자 32예, 남자 40예로 남자에 많았다. 두 악성종양 모두 60대에서 제일 많았다. 2) 주 증상은 상복부동통과 황달이었으며 평균 발병기간은 담당암은 4개월, 간외담도암은 2.8개월이었다. 3) 진단이 수술전에 확진된 예는 담당암이 17%,, 간외담도암이 51%이었으며 PTC나 ERCP가 수술전 진단에 큰 도움이 되었다. 4) 치료는 담낭암에서 38%, 간외담도암에서 17%의 근치수술을 실시하였고 2년 이상 생존한 예는 담낭암이 6예 간외담도암이 6예였고 가장 오래 생존한 경우는 담낭암이 5년 10개월, 간외담도암이 4년이었다. 상기한 결과로 저자는 앞으로 담도계악성종양의 치료를 위하여 PTC와 ERCP를 이용하여 조기에 발견하여야 하며, 근치수술뿐 아니라 담즙배액술도 장기생존을 기대할 수 있었다. 특히 수술전 혈청담색소치가 높은 환자에서는 PTCD를 이용하여 수술의 이환율과 사망율을 줄임과 동시에 근치수술도 가능하게 하는 것이 바람직하다고 생각한다.
[영문] Malignant tumors of the extrahepatic biliary trees ate used to include tumors arising from the common bile duct between hepatic bifurcation down to suprapancreatic portion, and the gall bladder. Obstructive jaundice might be an unique clinical finding of biliary tract malignancy, however, there is no specificclinical picture which represents tumor of each locations. Because of an inherent anatomic relation of biliary trees with the hepatic hilum, artery, and the portal vein, the majority of symptomatic patients are found to have unresectable lesions, therefore, a few case is subjected to curative surgery, and consequently, 5 year survivor is an infrequent occasion. And yet, there are tinny over-2 year survivors, among the patients who were undergone palliative biliary drainage only. Biliary drainage procedure appears to prolong life stance the majority of patients with biliary tree cancer are terminated with infection and hepatic failure rather than the disease progressed. The present study deals with clinical analysis of 41 case of the gall bladder carcinoma and 72 cases of the extrahepatic bile duct cancer operated upon at Yonsei Medical Center during 18 years from 1964 to 1981. 6th decade was the most frequently involved age group. Female patients were prone to have the gall bladder carcinoma. Contrarily, the extrahepatic bile duct cancers were more often found in male patients. The chief complaints were upper abdominal pain and jaundice. Duration of symptoms in the gall bladder cancer was 4 months, which longer than 2.8 months of the extrahepatic biliary cancer. 17% of the gall bladder cancers and 51% of the extrahepatic biliary cancers were correctely diagnosed preoperatively. Percutaneous transhepatic cholangiography and endoscopic retrograde cholangio pancreatography after gave excellent diagnostic clues .Curative resection was performed for 38% of the gall bladder cancer cases and 17% of extrahepatic biliary cancers and 6 cases of each survived more than 2 years. One of the gall bladder cancer patient survived 5 years and 10 months after simple cholecystectomyl and 4 years-survivor was the longest one among the patients tilth extrahepatic biliary cancer. Considerable number of patients on whom palliative surgery was performed survived more than 1 year. From these points of view, it would be concluded that early diagnosis and curative surgery are mandatory in surgical management of the biliary tree cancers. Unless the lesion is resectable, biliary drainage procedures, preferablly internal, should give a satisfactory palliation.
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