Kambayashi M
First Department of Surgery, Hokkaido University School of Medicine, Sapporo, Japan.
Hokkaido Igaku Zasshi. 1989 Sep;64(5):618-29.
To understand the spreading modes of cancer of the gallbladder concerning its surgical treatment, relation between the infiltration depth of the cancer and the lymph and blood vessel systems in the gallbladder was investigated. Clinico-pathological studies of 23 cases of the gallbladder carcinoma showed that the infiltration depth related to the degree of differentiation, invasiveness to lymph and blood vessel, and the metastasis of lymph nodes. Lymphatic and vascular systems of the gallbladder and bile duct were examined in 22 dogs. The vasculature in the wall of the gallbladder was divided into three layers. The veins at the liver bed were communicated with the intrahepatic portal veins. The lymphatic system in the wall was more clearly shown after obstruction of lymph vessels by ligation of soft tissues in the hepatoduodenal ligament and revealed four layers. The lymph vessels draining from the gallbladder descended along the cystic duct and the bile duct. They passed the portal and pancreatoduodenal lymph nodes and entered the cisterna chyli. In addition, lymph obstruction revealed other lymph tracts to the hepatic parenchyma of the hepatic hilum, retroperitoneum, celiac axis and the splenic vessel regions. The findings suggest that (1) simple cholecystectomy is suitable for the intramucosal carcinoma. (2) for the carcinoma infiltrating to the lamina muscularis, vascular invasion and spreading to the liver through the liver bed of gallbladder is suspected, and (3) for the carcinoma with subserosal infiltration, hepatic segmentectomy with complete resection of the extrahepatic bile duct and removal of the regional lymph nodes of the hepatoduodenal ligament and the vicinity of the gastropancreatic region are required because vascular and lymphatic spreads are suspected. Adjuvant therapy should be required and strict follow up survey should be maintained.
为了解胆囊癌的扩散模式及其外科治疗，研究了胆囊癌浸润深度与胆囊淋巴及血管系统之间的关系。对23例胆囊癌进行临床病理研究，结果显示浸润深度与分化程度、对淋巴和血管的侵犯以及淋巴结转移有关。对22只犬的胆囊和胆管的淋巴及血管系统进行了检查。胆囊壁内的血管分为三层。肝床处的静脉与肝内门静脉相通。通过结扎肝十二指肠韧带中的软组织阻塞淋巴管后，壁内淋巴系统显示得更清晰，呈现出四层。从胆囊引流的淋巴管沿胆囊管和胆管下行。它们经过门静脉和胰十二指肠淋巴结，进入乳糜池。此外，淋巴阻塞还显示出通向肝门肝实质、腹膜后、腹腔动脉轴和脾血管区域的其他淋巴途径。研究结果表明：（1）单纯胆囊切除术适用于黏膜内癌。（2）对于浸润至肌层的癌，怀疑有血管侵犯并通过胆囊肝床扩散至肝脏，（3）对于浆膜下浸润的癌，由于怀疑有血管和淋巴扩散，需要进行肝段切除术，同时完整切除肝外胆管，并清除肝十二指肠韧带及胃胰区域附近的区域淋巴结。应进行辅助治疗并保持严格的随访。
