2008 年 26 巻 p. 59-62
We report a patient with bile duct carcinoma with longer than 13-year survival with no surgical treatment but cholangioscopic MTC.
A 67-year-old female who had undergone coronary arterial bypass grafting was referred to our institution because of increased obstructive jaundice with bile duct carcinoma. Because she had undergone the coronary bypass operation using pedicle right gastroepiploic artery, it was not possible to apply pancreatoduodenectomy as radical operation. Therefore, percutaneous transhepatic cholangioscopic and X-ray image-guided MTC using Microtaze® (Heiwa Electronic Industrial Co. Ltd., Osaka, Japan) and 1.8 mm φ spherical, 5 mm φ bullet-shaped antennas was carried out under radiation of 45 watts and repetitions of 3-5 second duration. Serial cholangioscopic examination was conducted once a month for 3 years and sometimes disclosed involvements which were biopsied and shown to be recurrences histologically and followed by retreatment using MTC. The patient has been alive for more than 13 years since onset of jaundice, and is 81 years old. No adverse side effects were noted.
Our method uses not only coagulation but also a mild hyperthermic condition with a 5 mm φ antenna on the tumor margin at the depth of invasion as well as on the ductal lumen. MTC may be useful for palliation of inoperable patients with bile duct carcinoma, and sometimes for cure of the patients in the early stage of progression.
