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GaSb is a promising thermoelectric material that exhibits good electrical properties. However, it has a high lattice thermal conductivity (κ lat). Nanostructured bulk materials have been attracting interest because they effectively scatter phonons, significantly reducing κ lat. AgPb m SbTe m+2 (LAST-m) compounds have recently been reported to have low κ lat. These compounds have a NaCl structure, similar to that of binary PbTe, where Ag and Sb occupy the Pb site. In these compounds, two divalent Pb atoms are replaced with a monovalent Ag atom and a trivalent Sb atom to maintain charge compensation. In the present study, we reduced κ lat of GaSb by applying the same principle as in LAST-m. Specifically, we substituted Te for Sb and generated vacancies at the Ga site to maintain charge compensation. This produced compounds with chemical compositions of (GaSb)3(1−x)(Ga2Te3) x (x = 0, 0.05, 0.10, and 0.25), where GaSb and Ga2Te3 both have the zincblende crystal structure. We employed two different annealing conditions: annealing at 833 K followed by quenching, and annealing at 833 K followed by cooling to room temperature over 3 days. The former annealed samples with compositions of x = 0.05 and 0.10 had nanoscale Ga-rich precipitates and exhibited a large reduction in κ lat.

The primary goal of the study was to assess the efficacy of mindfulness-based meditation therapy on anxiety, depression, and spiritual well-being of Japanese patients undergoing anticancer treatment. A secondary goal was to assess the relationships among anxiety, depression, spiritual well-being, growth, appreciation, pain, and symptoms.The subjects were 28 patients who were receiving anticancer treatment. The subjects participated in two sessions of mindfulness-based meditation therapy, including breathing, yoga movement and meditation. Each patient was taught the program in the first session, then exercised at home with a CD, and subsequently met the interviewer in a second session after 2 weeks. Primary physicians recruited the patients and interviews were conducted individually by nurses or psychologists with training in the program. Patients completed preintervention and postintervention questionnaires on anxiety and depression (Hospital Anxiety and Depression Scale [HADS]), spiritual well-being (Functional Assessment of Chronic Illness Therapy-Spiritual [FACIT-Sp]), and appreciation, growth, pain, and symptoms.HADS scores significantly decreased from 12 +/- 5.3 to 8.6 +/- 6.3 (p = 0.004) after the intervention, and FACIT-Sp increased from 32 +/- 6.5 to 33 +/- 6.9 (p = 0.69), but the change was not significant. There were significant associations between FACIT-Sp and HADS (r = -0.78, p = 000), FACIT-Sp and growth (r = -0.35, p = 0.04), FACIT-Sp and pain (r = -0.41, p = 0.02), and growth and appreciation (r = 0.45, p = 0.009).Mindfulness-based meditation therapy may be effective for anxiety and depression in Japanese cancer patients, and spiritual well-being is related to anxiety and depression, growth, and pain. The negative correlation of spirituality with growth differs from the results of previous studies and the mechanism of this effect needs to be investigated further.

To investigate the prognostic factors of pancreatic cancer, a retrospective analysis of 193 patients who underwent curative resection was conducted. Of the 193 patients, 38 (20%) survived for more than 5 years, the 5-year survival rates for stages I, II, III, and IV disease being 41%, 17% 11%, and 6%, respectively. According to a multivariate analysis, lymph node metastasis, intrapancreatic perineural invasion, and portal vein invasion were significant prognostic factors. Subsequently, a subgroup analysis concerning nodal metastasis and intrapancreatic perineural invasion was performed in 126 patients with records of these histological findings. In the group of patients without nodal metastasis, the 5-year survival rate for those without perineural invasion was 75%, whereas that for those with perineural invasion was 29%, the difference in survival of these subgroups being significant (P

We report a very rare case of ileo-abdominal fistula caused by penetration of the ileal diverticulum. Small bowel diverticulosis is generally considered to be an innocuous condition. In this report, we describe a case of ileal diverticulitis associated with an abdominal wall abscess.

細胞外基底膜構成成分であるLamininと, 細胞外基底膜分解酵素であるMatrix metalloproteinase-3および細胞接着分子であるCD44の胆管癌組織における発現を免疫組織化学的に 検索し, 胆管癌の各種臨床病理学的因子との関係を検討した.各分子間では, LMとMMP-3の発現に負の相関を.各種臨床病理学的因子と各分子の発現の間では, 組織学的深達度とLM・CD 44発現に負, stageとLM・CD44に発現に負.stageとMMP-3発現に正, pnとMMP-3発現に正, リンパ節転移とLM発現に負の相関をそれぞれ認め, LM発現の有無で術後累積生存率に有意差を認めた.他の消化器癌と同様に胆管癌においても, その浸潤・進行に細胞外基質と基底膜分解酵素および接着分子の相互作用が関与する可能性が示唆された.

Endocrine tumor of the pancreas is potentially malignant. A multicenter analysis of these tumors was conducted to clarity the present status of their surgical management and the subsequent long-term surgical results. The Japan pancreatoduodenectomy (JPD) study group carried out the study; 368 patients were enrolled and variables related to tumor characteristics, surgery, and survival were retrospectively analyzed. There were 222 patients with functioning tumor and 143 patients with nonfunctioning tumor. Malignant tumor was found in 140 of 368 (38%) of the patients, and 63/140 (45%) of these patients had metastatic lesion; the most common site of the metastasis was liver 34/136 (25%), followed by regional lymph nodes 26/136 (19%). Pancreatic resection was performed in 91% of patients with nonfunctional tumor and in 83% of those with malignant tumor, and 73% of the pancreatic resections were done with lymph node dissection. The overall 5-year actuarial survival rate was 76% in patients with malignant tumor. The actuarial 5-year survival rate was 93% in the patients without metastasis and 83% in patients who received curative resection. Multivariate analysis showed that the presence or absence of synchronous metastasis was the sole significant prognostic factor. The results suggest that: (i) malignant endocrine tumor of the pancreas is a curable malignancy when pancreatic resection with lymph node dissection is adopted and (ii) that synchronous metastasis is the dominant prognostic factor.

胆石形成に関する実験的研究 (学位論文) が胆道外科に進むきっかけとなり, 膵頭十二指腸切除術が胆道癌専門の外科医に育ててくれた.経皮経肝胆道ドレナージは胆道癌の診断, 治療とその応用に必須の手技であると重要視し, 手技の安定に力を注ぎ, 術後合併症の防止と患者集めに大いに貢献した. 胆嚢癌では切除例142例, 切除率67.0%, 在院死亡率3.5%で5生率はm, pm95.5%, ss49.2%, se, si16.9%で全体としては43.3%であった.胆管癌では切除例171例, 切除率65.0%で, 治癒切除例の5生率は肝管・上部35.0%, 中下部35.5%で, 不満足な成績であった. 乳頭部癌では症状, 診断, 進展度診断, 予後を左右する因子について詳述した. 切除例は106例, 切除率85.5%, 在院死亡率は2.4%で, 5生率はリンパ節転移陽性例44.4%, 全体では56.6%であり, 35例の5生例, 14例の10生例を得ている.

Hilar bile duct resection, by which only the bile duct is resected, was carried out in 31 patients with bile duct carcinoma at the hepatic hilus. However, curative resection was possible in only 4 patients (12.9%). The postoperative 1-, 3-, and 5-year survival rates were 58.1%, 19.4%, and 7.7%, respectively. These results indicate that treatment of this hilar bile duct carcinoma by hilar bile duct resection is of limited value. We believe that this operative procedure should be used only for papillary or nodular carcinoma at the hepatic confluence at relatively early stages of Bismuth's type I or II.

This report is based on an analysis of the recurrent patterns and post-treatment clinical outcome of 78 patients following hepatectomy for hepatocellular carcinoma (HCC). Patients with a single recurrent tumor (group A;n=41) often had multicentric carcinogenesis (41.7%) and were treated locally; i.e., by re-resection or by percutaneous ethanol injection therapy (PEIT). Many of them (42.9%) followed the “curative pattern,” with good prognosis (70.3% 5-year survival rate). Although 6 of the patients with two or three recurrent tumors (group B;n=19) had multicentric carcinogenesis that could be treated locally, 13 of the 19 followed the “non-curative pattern,” with a poor prognosis after recurrence (14.8% 3-year survival rate after recurrence). The primary tumors of the patients with multiple or infiltrating type (group C;n=18) were advanced and these patients had metastatic recurrence, thereby following the “early death pattern” (58.8%) with a poor prognosis (30% 5-year survival rate). For group C patients, hepatectomy was regarded as part of a multidisciplinary treatment regimen that included aggressive postoperative chemotherapy as a necessary component.

Pancreatojejunal sutural insufficiency occurring after pancreatoduodenectomy and countermeasures are discussed. In the Department of Surgery at Kurume University School of Medicine, 318 patients underwent pancreatoduodenectomies. The present study includes 15 of these patients, all of whom had pancreatojejunal sutural insufficiency. The frequency of sutural insufficiency was 4.7%. Five patients had bile duct cancer, 5 had cancer of the papilla of Vater, 2 had a carcinoma of the pancreatic head, 1 each had gallbladder cancer, chronic pancreatitis, and papillitis. Six (40%) of the 15 patients died during hospitalization. The presence or absence of sutural insufficiency was confirmed mainly by radiography and determining the properties and amylase levels of the drainage fluid. There was no significant difference due to the method of anastomosis. End-to-side anastomosis had a rate of 5 (5.9%) of 85 patients, while end-to-end had 10 (4.3%) of 233 patients. The sutural insufficiency was manifested as a major leakage in 6 patients and a minor leakage in 9. The degree of lymph node dissection was D0 in 6.1%, D1 in 1.4%, D2 in 4.8% and D3 in 10.8%, with a high incidence of sutural insufficiency in D3 patients. The pancreatic duct diameter was smaller than 4 mm in 10, 5-7 mm in 4 and over 8 mm in 1 patient. The intraoperative pancreatic findings were a soft pancreas in 8, slightly hard in 3, and hard in 4 patients. Fibrosis of the pancreas was normal to slight in 11 and moderate in 4 patients. Drainage by relaparotomy was performed in 4 of the 6 patients with major leakages to control sutural insufficiency, and the other 2 underwent continuous aspiration with an intraperitoneal drain inserted during the operation. The 9 patients with minor leakage underwent conservative treatment including continuous aspiration via an intraperitoneal drain inserted during surgery, fasting, intravenous hyperalimentation, and antibiotic administration. All of the patients with major leakage died from an associated occurrence of hepatic insufficiency, renal insufficiency, intraperitoneal hemorrhage or diffuse peritonitis during hospitalization. However, 8 of the 9 patients with minor leakage had some healing, and the 1 remaining patient developed a pancreatic fistula. The frequency of pancreatojejunal sutural insufficiency was high in patients with minimal pancreatic fibrosis, with soft pancreatic tissue without dilatation of the pancreatic duct, and with relatively good pancreatic function.

最近,腹部超音波診断法(ECHO)で,単発あるいは多発の肝内小結節性病変を指摘され,肝生検施行すると凝固壊死を伴う肉芽組織が採取され,質的診断が困難な症例を著者らの施設では,しばしば経験するようになった.このような凝固壊死を呈する肉芽性結節14例について検討した.対象とした14例は臨床的に2例を除きウイルスマーカーは陰性,腫瘍マーカーは全例が陰性であり,ECHOでは14例中10例(71.4%)が結節内に2本の線状エコー(bead sign)を有し,病理学的には凝固壊死と肉芽組織で構成され,凝固壊死部をさらに詳しく検討すると,著明な好酸球浸潤や14例中7例(50%)にCharcot-Leyden結晶が認められることから,寄生虫感染(特にイヌ・ネコ蛔虫症や肝蛭症)との密接な関連が示唆される病変である.

In this multicenter randomized trial, the efficacy of combination chemotherapy using 5-fluorouracil, doxorubicin and mitomycin C (arm A) was compared with that of 5-fluorouracil alone (arm B) in 81 patients with nonresectable carcinomas of the pancreas or biliary tract. There were no significant differences between treatment arms regarding the median time to progressive disease, median survival time, palliative effects or toxicities. It was concluded that combination chemotherapy is feasible but cannot be recommended.

Postoperative metachronous multicentric carcinogenesis of hepatocellular carcinoma (HCC) was studied by comparison of the histologic grade of resected and recurrent tumors in 31 cases which underwent ultrasound-guided fine-needle biopsies for the initial recurrent tumors with diameter of less than 20 mm. The criteria that the cases in which recurrent tumors show well-differentiated HCC without regard to the differentiation of resected tumors should be multicentric carcinogenesis, and that the cases in which recurrent tumors show moderate or poorly differentiated HCC with the same or lower degree of differentiation compared with the differentiation of resected tumor was consistent with metastasis, were applied. In 16 (51.6%) out of the 31 cases, multicentric carcinogenesis was thought to occur (multicentric group). In 14 cases, recurrence was thought to be metastasis (metastatic group). The multicentric group tended to have smaller diameters in resected tumors and a high incidence of the association of liver cirrhosis and adenomatous hyperplasia. In gross classification of resected tumors, six cases of all single nodular with perinodular tumor growth type and infiltrative type had metastatic recurrences, and multicentric carcinogenesis was often seen in cases of single nodular type, multinodular type and confluent multinodular type. In the multicentric group, recurrence occurred at every postoperative period as long as 65 months including four cases of early recurrence within 6 months and six cases of late recurrence later than 24 months. On the contrary, in 12 cases in the metastatic group the recurrent interval ranged from 6 to 19 months.

A recent progress in operative techniques and improvement in pre-, intra- and postoperative patient care have enabled the positive application of pancreaticoduodenectomy even to aged patients. Pancreaticoduodenectomy was performed for carcinoma in region of the head of the pancreas in 186 patients in the period from January 1965 to December 1990, including 135 patients under 70 years and 51 patients over 70 years. In this study, comparison was made between two 'age groups, aged group over 70 years and younger group under 70 years. Some underlying diseases were found before operation in 50.4% of younger and 62.7% of aged patients, giving a slightly higher percentage in the group of aged patients. Significant differences was observed between the groups for the time required for operation (p

Excepting operation-related deaths, including deaths within 30 days after operation and hospital deaths, and absolute non-curative resection cases, 171 resected cases of Hepatocellular carcinoma (HCC) were classified into 3 groups in terms of Kobayashi's risk score, namely, group A (score 7.5 or above; 29 cases), group B (7.4-6.0; 94) and group C (5.9 or below; 48). Results were: 1) The number of cases with a score of 6.0 or above was 123 out of 171 cases (71.9%). 2) In comparison with the other 2 groups, both postoperative survival rate and non-recurrent rate were significantly poor in group A (p

肝後下区域(S6)の腹側表面に,癌腫の一部が露出し存在した22×21mmの小肝細胞癌に対して,新たに開発した手術機器を用いて,本邦で初めて,腹腔鏡下マイクロ波凝固壊死療法を行ったところ,本法は,小肝細胞癌に対する新しい治療法として,有用と考えられたので報告した.症例は63歳,男性.肝機能,および凝固系検査の術後推移をみると,術後1日目に,GOTは423K.U, GPTは241K.U, T. Bil.は2.1mg/100mlと上昇した.また,術後,凍結血漿をまったく使用しなかったため,HPTは42%, PTは48.3%に低下した.しかし,すべての検査値は,術後7日目には術前値に復した.胃管は,術翌日には抜去し,2日目より食事を開始した.術後3週目に撮影したCTでは,治療部は癌腫を含め,著しくlow density areaに陥り,まったくenhanceされず,治療効果も充分であると判断された.また,術後合併症はまったく認められなかった.

Pancreaticoduodenectomy (PD) with preservation of the arcade in the head of the pancreas was performed in a 73-year-old male with ampullary adenocarcinoma associated with occlusion of the common hepatic artery (CHA) in another hospital. He developed active bleeding from his drain site, at 18 days after the operation. He was transferred to our hospital for emergent embolization. Celiac arteriogram showed complete occlusion of the CHA, posterior superior pancreaticoduodenal artery (PSPDA) pseudoaneurysm 1.7 cm in diameter and development of an enlarged tortuous dorsal pancreatic artery (DPA), posterior pancreatico-duodenal artery (PPDA), and gastroduodenal artery (GDA). Complete hemostasis was obtained without major complications by the transcatheter arterial embolization (TAE) with microcoils.

肝細胞癌に対し, 従来の肝流入血遮断法に併用して, パルーンカテーテルによる選択的肝静脈遮断を行って肝中央2区域切除を施行した. カテーテルは術中経肝的に超音波ガイド下に経皮経肝的門脈造影の際のカテーテル挿入手技に準じて, 右および中肝静脈それぞれに挿入した. 切除線右側の右肝静脈に沿った切除の際は, 肝門部でのグリソン氏輪右枝遮断に併用してバルーンによる右肝静脈根部の遮断を, 切除線左側の中および左肝静脈近傍に沿った切除の際は, Pringle法による流入血全遮断に併用して中肝静脈根部の遮断を行うことにより, 良好な無血術野が得られた. 肝授動も肝鎌状間膜の切離のみで切除しえた. 術中出血量は1,100mlで, 術後の肝機能推移も良好であり, 本法は系統的切除あるいは腫瘍が主幹肝静脈に接して存在する場合などで, 肝切除の際, 肝静脈からの出血が予想される例には有用な方法と思われた.

超音波検査にて高エコー像を呈する肝細胞癌の病理組織像について検討した.対象とした3cm以下の肝細胞癌切除例88例中,高エコー像を呈したのは34例(38.6%)であり,腫瘍径別では1cm以下では9例中1例,1.1～2.0cmでは38例中17例,2.1～3.0cmでは41例中16例と1.1～2.0cmで最も高頻度であった.高エコーの組織像としては,癌細胞の脂肪化20例,偽腺管構造6例,Peliosis hepatis様に拡張した血洞より成る6例,淡明細胞化および線維化が各1例にみられ,脂肪化によるものが最も高頻度であった.なお,脂肪化により高エコー像を呈した症例では,脂肪化は癌組織の1/3以上に認められるもので,また,高エコーを呈する偽腺管型肝細胞癌は偽腺管の嚢胞状拡張を伴うものに限られていた.

We report a case of primary duodenal carcinoma which had partial responce by preoperative chemotherapy. A 65-year-old man visited a near clinic with the chief complaint of lower abdominal pain. Inspection, palpation and upper gastrointestinal barium studies showed that the patient had a duodenal abnormality. Ulcerative lesion of the duodenum and colon carcinoma were suspected and refersed to our hospital. After admission the abdominal tumor became larger and jaundice developed. From preoperative endoscopy of the duodenum and biopsy, malignant lymphoma was considered most probable and chemotherapy (CHOP) was started. After 2 courses of chemotherapy, significant decrease in the abdominal tumor mass was noted. Pancreatoduodenectomy with partial resection of transverse colon was performed. Postoperative course was uneventful and additional chemotherapy was done. The patient is closely followed on ambulant basis.

肝外胆管癌が血管造影で腫瘍濃染像を呈することは比較的まれであるが著者らは腫瘍濃染像を呈した肝外胆管癌の1症例を経験したので報告した.症例は68歳の男性, 主訴は上腹部痛, 肝機能異常を指摘され入院後, 諸検査の結果, 胆管癌と診断され手術を施行した.病理組織診断は乳頭管状腺癌であった.血管造影上腫瘍濃染像がどのような原因に由来するものか検討した結果, 本腫瘍の間質には毛細血管の増殖が非常に豊富で, この毛細血管内に造影剤がプーリングして腫瘍が濃染したものと思われた.また本腫瘍の発生学上の母組織は, あたかも消化管由来を思わせるごとき特徴を有していた.

BACKGROUND To the authors' knowledge, the significance of postoperative adjuvant chemotherapy in pancreaticobiliary carcinoma has not yet been clarified. A randomized controlled study evaluated the effect of postoperative adjuvant therapy with mitomycin C (MMC) and 5-fluorouracil (5-FU) (MF arm) versus surgery alone (control arm) on survival and disease-free survival (DFS) for each specific disease comprising resected pancreaticobiliary carcinoma (pancreatic, gallbladder, bile duct, or ampulla of Vater carcinoma) separately. METHODS Between April 1986 and June 1992, a total of 508 patients with resected pancreatic (n = 173), bile duct (n = 139), gallbladder (n = 140), or ampulla of Vater (n = 56) carcinomas were allocated randomly to either the MF group or the control group. The MF group received MMC (6 mg/m2 intravenously [i.v.]) at the time of surgery and 5-FU (310 mg/m2 i.v.) in 2 courses of treatment for 5 consecutive days during postoperative Weeks 1 and 3, followed by 5-FU (100 mg/m2orally) daily from postoperative Week 5 until disease recurrence. All patients were followed for 5 years. RESULTS After ineligible patients were excluded, 158 patients with pancreatic carcinoma (81 in the MF group and 77 in the control group), 118 patients with bile duct carcinoma (58 in the MF group and 60 in the control group), 112 patients with gallbladder carcinoma (69 in the MF group and 43 in the control group), and 48 patients with carcinoma of the ampulla of Vater (24 in the MF group and 24 in the control group) were evaluated. Good compliance (> 80%) was achieved with MF treatment. The 5-year survival rate in gallbladder carcinoma patients was significantly better in the MF group (26.0%) compared with the control group (14.4%) (P = 0.0367). Similarly, the 5-year DFS rate of patients with gallbladder carcinoma was 20.3% in the MF group, which was significantly higher than the 11.6% DFS rate reported in the control group (P = 0.0210). Significant improvement in body weight compared with the control was observed only in patients with gallbladder carcinoma. There were no apparent differences in 5-year survival and 5-year DFS rates between patients with pancreatic, bile duct, or ampulla of Vater carcinomas. Multivariate analyses demonstrated a tendency for the MF group to have a lower risk of mortality (risk ratio of 0.654; P = 0.0825) and recurrence (risk ratio of 0.626; P = 0.0589). The most commonly reported adverse drug reactions were anorexia, nausea/emesis, stomatitis, and leukopenia, none of which were noted to be serious. CONCLUSIONS The results of the current study indicate that gallbladder carcinoma patients who undergo noncurative resections may derive some benefit from systemic chemotherapy. However, alternative modalities must be developed for patients with carcinomas of the pancreas, bile duct, or ampulla of Vater. Cancer 2002;95:1685–95. © 2002 American Cancer Society. DOI 10.1002/cncr.10831

Serous cystadenocarcinoma of the pancreas is a rare entity. We report a primary tumor of the pancreas in a 56-year-old woman that was histologically indistinguishable from microcystic adenoma, but which behaved in a malignant fashion. Metastatic lesions were found in the liver at the time of the initial operation. Nine years after the initial operation, new metastatic liver nodules were found, and the histologic characteristics of these lesions were quite similar to those of the pancreatic neoplasm. This is a very rare case which may support the existence of the entity, serous cystadenocarcinoma of the pancreas.

Between January 1965 and September 1995, 330 patients underwent pancreatoduodenectomy in our institution. In 249 cases, we performed the Child method of reconstruction after pancreatoduodenectomy. Of these patients, 299 underwent pancreatoduodenectomy because of malignant disease and 19 died in the hospital after the operation; the mortality rate was 5.8%. We must be aware of certain complications after pancreatoduodenectomy, especially anastomotic leakage of the pancreatiocojejunostomy. It 16 cases of pancreatic fistula, 7 patients died of this complication. Five-year survival rates of patients with carcinoma of the pancreas, bile duct, and papilla of Vater were 17.3%, 19.7%, and 56.2%, respectively. In cases of carcinoma of the papilla of Vater with no lymph node involvement, the 5-year survival rate was 64.9%; for cases with lymph node involvement, it was 40.0%. Many more strategies must be developed to obtain a better outcome in cases of carcinoma of the pancreas and bile duct. The most important need is to prevent metastasis of carcinoma to the liver in these patients.

A 51-year-old man had repeated admissions and discharges from the hospital for alcohol dependence and alcoholic hepatitis. Thereafter, with a diagnosis of chronic pancreatitis, he was examined on an outpatient basis. He presented with right hypochondriac pain as the chief complaint, and was admitted to the hospital because of a suspected acute exacerbation of chronic pancreatitis. Pyrexia and jaundice were present from about the 5th hospital day, and he was admitted to Kurume University Hospital with a diagnosis of obstructive icterus. Percutaneous transhepatic biliary tract drainage (PTBD) was immediately performed. A roentgenogram revealed moderate dilatation of the extrahepatic bile ducts and stricture of the intrapancreatic common bile duct. No calculi were observed in the gallbladder or bile ducts by ultrasonography of the abdominal region. The main pancreatic duct was dilated to 10 mm, and a strong echo, probably a calculus, was observed in the main pancreatic duct. Pancreatoduodenectomy was performed with a diagnosis of stricture of the common bile duct due to chronic pancreatitis with a pancreatic stone. Examination of the excised specimens revealed a rigid pancreatic head; and when the common bile duct was incised, no stricture was observed. A milk-white calculus about 10 mm in diameter was observed in the common channel of the lower portion of the common bile duct. The orifice of the pancreatic duct was also observed at the same site. The common channel was about 20 mm long, and malfusion of the pancreatobiliary ducts was observed. The obstructive icterus was due to an impaction of the pancreatic stone at the confluence of the pancreatobiliary ducts. The calculus was composed of calcium carbonate, and the histopathological findings in the pancreas showed chronic pancreatitis.

To minimize intraoperative bleeding and allow more accurate resection, we have devised a new technique for hepatectomy. In addition to occlusion of the afferent vessels, we occlude the hepatic vein at the hepatocaval junction using a balloon catheter inserted transhepatically under intraoperative ultrasonic guidance. We have performed eight hepatectomies using this method. A sequence of 15 minutes of vascular occlusion followed by 5 minutes reperfusion was repeated throughout the operation, and the total ischemic time ranged from 45 to 90 minutes. This method greatly decreased intraoperative bleeding without causing significant elevation of the postoperative transaminase or lactic dehydrogenase levels when compared with occlusion of only the afferent vessels or nonischemic resection using a microwave tissue coagulator in patients undergoing equivalent resections. Also, the postoperative prothrombin time recovered to a significantly higher level, and there were no fatal postoperative complications using this method. Our method is useful for systematic hepatic resection along the hepatic vein or for resection of tumor sited at the confluence of the hepatic vein.

Cholangiocellular carcinoma (CCC), the malignant tumor arising from epithelial cells of the intrahepatic bile duct, has been classified as a primary liver cancer, although CCC has occurred less frequently than hepatocellular carcinoma (HCC) in Japan [1]. Most CCCs are advanced because a system for early diagnosis has not been established [2], and even though CCC is resectable, the prognosis is generally unfavorable [3–5]. We therefore studied clinically the 36 patients with CCC encountered at our hospital, and reported the current status of surgical treatment in Japan.

Ten patients with cirrhosis, in whom small mass lesions were detected by imaging techniques and histological diagnosis of the resected specimens was difficult, are described. There were 17 grossly discrete lesions measuring 10 × 8 mm to 27 × 22 mm. Four were compatible with so-called adenomatous hyperplasia showing no histological features of malignancy, and eight were equivocal as to whether they were benign or malignant. The other five lesions (in four patients) were hepatocellular carcinoma, co-existing with apparently benign lesions. The eight equivocal lesions were eventually judged to be highly differentiated hepatocellular carcinomas. These benign-appearing lesions, found by advanced imaging in patients with cirrhosis, create a serious problem in regions where primary liver cancer is endemic among cirrhotics, and hepatic resection is the preferred treatment. It is possible that these lesions represent a transition from adenomatous hyperplasia occurring in cirrhotic livers to hepatocellular carcinoma through a histologically equivocal state and that the current morphological methods are inadequate for differentiating malignant from benign lesions.

肝細胞癌(HCC)と鑑別が困難であった肝adenomatous hyperplasia (AH) 1例と,HCCに併存して認められたAH 2例の病理形態学的特徴について報告する.肉眼的には被膜の形成はなく,色調は均一で,出血,壊死はみられない結節であり,背景病変は肝硬変症であった.組織学的には,グリソン鞘が腫瘤辺縁部のみならず中心部にも存在した.腫瘤を形成する細胞の異型性は乏しいが,部分的にはhypercellularityを示す部が認められた.索状構造や偽腺管様構造などの特殊な細胞配列はみられなかった.腫瘤境界部は,肝硬変の線維性隔壁により形成されているが,膨脹性発育を示す部もみられた.

外科的に切除された最大径3cm以下の肝細胞癌59例について(術死例は除く)再発が確認された23例と非再発例36例とを病理形態学的に検討した.肉眼分類は「原発性肝癌取扱い規約,第2版」の単結節型,単結節周囲増殖型,多結節癒合型,多結節型,塊状型の5型によった.単結節型が最も多く,次いで単結節周囲増殖型が多く塊状型は1例もみられなかった.再発率は肉眼型別では単結節型が他型に比べて低い傾向が認められたが有意差は認められなかった.しかし脈管侵襲は単結節型では他の3型に比べて有意(p