Endoscopic microwave coagulation therapy (EMCT) was successfully applied to female patients aged 79 and 82 with obstructive jaundice due to lower bile duct carcinoma, because of their refusal pancreatoduodenectomy (PD). A single 10-second exposure of microwave (50 Wm 2450 MHz) was delivered 15 to 20 times during each treatment to the cancerous tissue using a monopoler shielded wire electrode under guidance of a percutaneous cholangioendoscopy. Treatment was repeated a total of three or six times at intervals of 1 week, and an expandable metallic stent was plased after recanalization of bile duct and negative tests for cancer cells. Supplementary radiation therapy (50.4 Gy) was performed after EMCT, and no complications were encountered. Patients have subsequently lived well for 12 and 11 months without jaundice. These results indicate that EMCT for patients with lower bile duct cancer and high operative rick might be an effective alternative for PD.


患者は結節浸潤型下部胆管癌の79歳と82歳の女性で,幽門部胃癌切除の既往,糖尿病,高血圧などの合併症があり,手術を望まなかったため,胆道鏡下マイクロ波凝固療法を施行した。治療には弾頭型ケーブル電極を用いて1回10秒間のマイクロ波(50W)を15〜20回照射した。これを1〜2週間隔で3〜4回繰り返し,放射線治療を追加した。全治療期間を通じて特記する合併症なく,治療開始後9ヶ月経過した現在,局所再発の所見はない。本治療法は門脈から距離のある限局型下部胆管癌で,手術希望のない高リスク患者には安全で有効な治療手段であった。

胆管腫瘍;高周波療法;マイクロ波照射;内視鏡;放射線療法;併用療法;症例報告;ヒト;老人;ステント
M.S. BILIARY