{"created":"2023-05-25T05:25:46.346165+00:00","id":4254,"links":{},"metadata":{"_buckets":{"deposit":"7f0a5e34-c74f-4a4e-85a8-17d05bc0cd7f"},"_deposit":{"created_by":17,"id":"4254","owners":[17],"pid":{"revision_id":0,"type":"depid","value":"4254"},"status":"published"},"_oai":{"id":"oai:yamagata.repo.nii.ac.jp:00004254","sets":["29:31:124:125"]},"author_link":["13555","13550","13549","13548","13538","13542","13540","13541","13537","13543","13547","13545","13559","13560","13554","13553","13539","13556","13546","13551","13558","13544","13552","13557"],"item_3_alternative_title_18":{"attribute_name":"その他の言語のタイトル","attribute_value_mlt":[{"subitem_alternative_title":"Clinicopathological study for middle bile duct cancer : especially surgical significance of bile duct resection"}]},"item_3_alternative_title_19":{"attribute_name":"タイトル（ヨミ）","attribute_value_mlt":[{"subitem_alternative_title":"チュウブ タンカンガン ノ リンショウ ビョウリガクテキ ケントウ : トクニ タンカン セツジョジュツ ノ イギ ニ ツイテ"}]},"item_3_biblio_info_6":{"attribute_name":"書誌情報","attribute_value_mlt":[{"bibliographicIssueDates":{"bibliographicIssueDate":"2018-02-15","bibliographicIssueDateType":"Issued"},"bibliographicIssueNumber":"1","bibliographicPageEnd":"21","bibliographicPageStart":"15","bibliographicVolumeNumber":"36","bibliographic_titles":[{"bibliographic_title":"山形大学紀要. 医学 : 山形医学"},{"bibliographic_title":"Bulletin of the Yamagata University. Medical science : Yamagata medical journal","bibliographic_titleLang":"en"}]}]},"item_3_description_42":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"subitem_description":"論文(Article)","subitem_description_type":"Other"}]},"item_3_description_5":{"attribute_name":"内容記述","attribute_value_mlt":[{"subitem_description":"【背景】いまだ予後不良な胆管癌の浸潤には、胆管の垂直方向と水平方向との２つの進展形式が存在する。今回中部胆管癌において、とくに胆管断端の肝臓側（hm）、十二指腸側（dm）について臨床病理学的に検討し、胆管切除術（BDR）の意義について考察した。\n【方法】当科で経験した中部胆管癌の切除例22例を対象とした。深達度、リンパ節転移、神経浸潤、肝臓側胆管断端（hm）、十二指腸側胆管断端（dm）の癌の有無、術後化学療法の有無などの臨床病理学的因子と予後について検討するとともに、胆管切除術（BDR）の12例と膵頭十二指腸切除術（PD）を行った10例の予後を比較検討した。\n【結果】BDR+PD全体の平均年齢は71.1歳であった。BDR群の平均年齢は74.3歳、PD群は67.3歳で有意にBDR群の方が高齢であった（p<0.05）。中部胆管癌全症例（n=22）の３生率は53.6％、５生率は32.1％であった。BDR群の３生率54.5％、５生率20.5％で、PD群の３生率55.6％、５生率41.7％で有意差を認めなかった。BDR＋PD（n=22）群の深達度別には線維筋層（fm）の４例とも生存中であった。漿膜下層（ss）11例の３生率57.1％、５生率28.6％であった。漿膜露出（se）７例の３生率は16.7％で５年生存例はなかった。\n　BDR+PD（n=22）群のリンパ節転移陰性13例の３生率75.9％、５生率51.4％で、リンパ節転陽性９例の３生率15.6％で５年生存はなかった（p<0.01）。神経浸潤陰性17例の３生率44.4％、５生率17.8％で、神経浸潤陽性５例の３生率、５生率はともに17.8％であった（p<0.05）。\n　BDR群（n=12）のhm，dmともに陰性（n=4）の５生率は75％であった。 hm，dmともに陽性（n=6）の３生率60％で、５年生存はなかった。hm，dmともに陽性例の平均生存期間は37.5ヵ月であった。\n　BDR+PD群（n=22）で術後補助化学療法を施行した11例と施行しなかった11例の生存率に有意差を認めなかった。\n【結論】中部胆管癌に対しては原則としてPDが行われるが、BDRでもhm，dmともに陰性でリンパ節転移や神経浸潤のない中部胆管限局例の５生率は75％であり、良好な予後を期待できる。また、hm，dmともに陽性であっても平均生存期間は37.5ヵ月であり、閉塞性黄疸、胆管炎、肝膿瘍を予防するためのBDRの意義はあると考える。","subitem_description_type":"Other"}]},"item_3_full_name_2":{"attribute_name":"著者(ヨミ)","attribute_value_mlt":[{"nameIdentifiers":[{"nameIdentifier":"13553","nameIdentifierScheme":"WEKO"}],"names":[{"name":"ヒライ, イチロウ"}]},{"nameIdentifiers":[{"nameIdentifier":"13554","nameIdentifierScheme":"WEKO"}],"names":[{"name":"キムラ, ワタル"}]},{"nameIdentifiers":[{"nameIdentifier":"13555","nameIdentifierScheme":"WEKO"}],"names":[{"name":"ワタナベ, トシヒロ"}]},{"nameIdentifiers":[{"nameIdentifier":"13556","nameIdentifierScheme":"WEKO"}],"names":[{"name":"テズカ, コウジ"}]},{"nameIdentifiers":[{"nameIdentifier":"13557","nameIdentifierScheme":"WEKO"}],"names":[{"name":"スガワラ, シュウイチロウ"}]},{"nameIdentifiers":[{"nameIdentifier":"13558","nameIdentifierScheme":"WEKO"}],"names":[{"name":"オカザキ, シンジ"}]},{"nameIdentifiers":[{"nameIdentifier":"13559","nameIdentifierScheme":"WEKO"}],"names":[{"name":"タカハシ, リョウスケ"}]},{"nameIdentifiers":[{"nameIdentifier":"13560","nameIdentifierScheme":"WEKO"}],"names":[{"name":"アシトミ, ユウヤ"}]}]},"item_3_full_name_3":{"attribute_name":"著者別名","attribute_value_mlt":[{"nameIdentifiers":[{"nameIdentifier":"13545","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Hirai, Ichiro"}]},{"nameIdentifiers":[{"nameIdentifier":"13546","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Kimura, Wataru"}]},{"nameIdentifiers":[{"nameIdentifier":"13547","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Watanabe, Toshihiro"}]},{"nameIdentifiers":[{"nameIdentifier":"13548","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Tezuka, Koji"}]},{"nameIdentifiers":[{"nameIdentifier":"13549","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Sugawara, 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特に胆管切除術の意義について","item_titles":{"attribute_name":"タイトル","attribute_value_mlt":[{"subitem_title":"中部胆管癌の臨床病理学的検討 : 特に胆管切除術の意義について"}]},"item_type_id":"3","owner":"17","path":["125"],"pubdate":{"attribute_name":"公開日","attribute_value":"2018-02-15"},"publish_date":"2018-02-15","publish_status":"0","recid":"4254","relation_version_is_last":true,"title":["中部胆管癌の臨床病理学的検討 : 特に胆管切除術の意義について"],"weko_creator_id":"17","weko_shared_id":-1},"updated":"2023-05-25T06:28:21.417358+00:00"}