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We conducted this study to evaluate the optimal hepatic resection for pT2 and pT3 advanced carcinoma of the gallbladder without invasion of the hepatoduodenal ligament. We conducted a questionnaire survey regarding 4,243 cases of carcinoma of the gallbladder treated during the recent 10-year period at 112 institutions belonging to the Japanese Society of Biliary Surgery. The questionnaires included questions on preoperative-diagnosis, complications, treatment, and surgical treatment, procedures of resection, surgical result, path histological findings, mode, and site of recurrence, additional post-operative treatment. They included 293 pT2 and 192 pT3 R0 cases, which were negative for hepatoduodenal ligament invasion, and the cumulative survival rates and sites of postoperative recurrence in the form of liver metastasis, were retrospectively analyzed in these 485 cases. There were no significant differences in survival rate or recurrence rates in the form of liver metastasis between the groups that underwent resection of the gallbladder bed, the group that underwent segmentectomy 4a+5, and the group that underwent hepatectomy in patients with of both pT2 or pT3 gallbladder cancers. Our results also did not show that liver metastasis to segment 4a5 alone was particularly common. For gallbladder cancer, neither with hepatoduodenal ligament invasion nor hepatic invasion, resection of the gallbladder bed is more preferable for surgical hepatic procedure. For gallbladder cancer that invades any hepatic sites, a hepatic surgical procedure that could eliminate surgical margins would be desirable.

胆道再建20症例を対象にDIC併用造影MDCT（以下:Dual contrast DIC-CT）を行い肝内胆管から吻合部，挙上空腸および胆管壁とその周囲の形態的観察の可能性につき検討した．胆管から吻合部にかけての胆管短径および長径計測可能は右前枝15/20例（75％），右後枝15/20例（75％），左枝10/18例（55.5％），吻合部16/24吻合（66.6％）で，仮想的内腔面観察可能は順に15/20例（75％），11/20例（55％），10/18例（55.5％），11/20例（55％）であった．胆管径計測，内腔面観察不能の原因はpneumobiliaと造影剤による描出不良であった．Dual contrast DIC-CTによる胆管壁の観察から胆管炎を繰り返す症例で壁厚の測定が可能であった．また術後一過性の原因不明発熱を繰り返す症例で吻合部胆管に接する嚢胞性病変を認めその原因と推察された．Dual contrast DIC-CTを用いた検討により胆道再建後症例の病態解明に役立つ検査の一つになり得るものと思われた．

We assessed the significance of an extra bile duct resection by comparing the survival of patients with advanced gallbladder carcinoma who had resected bile ducts with those who had preserved bile ducts. A radical cholecystectomy that includes extra bile duct resections has been performed without any clear evidence of whether an extra bile duct resection is preventive or curative.We conducted a questionnaire survey among clinicians who belonged to the 114 member institutions of the Japanese Society of Biliary Surgery. The questionnaires included questions on the preoperative diagnosis, complications, treatment, and surgical treatment, resection procedures, surgical results, pathological and histological findings, mode and site of recurrence, and the need for additional postoperative treatment. A total of 4243 patients who had gallbladder carcinoma and were treated from January 1, 1994 to December 31, 2003 were identified. The 838 R0 patients with pT2, pT3, and pT4 advanced carcinoma of the gallbladder for which there was no cancer invasion to the hepatoduodenal ligament or cystic duct in the final analysis.The 5-year cumulative survival, postoperative complications, postoperative lymph node metastasis, and local recurrence along the hepatoduodenal ligament were not substantially different between the resected bile duct and the preserved bile duct groups.Our retrospective questionnaire survey showed that an extrahepatic bile duct resection had no preventive value in some patients with advanced gallbladder carcinoma in comparison to similar patients who had no such bile duct resection. An extrahepatic bile duct resection may therefore be unnecessary in advanced gallbladder carcinoma without a direct infiltration of the hepatoduodenal ligament and the cystic duct.

The fracture arrest of high pressure gas pipelines is one of the keen subjects for application of high strength line pipes. To examine the arrestability of high strength line pipes against crack propagation, several full scale fracture propagation tests have been conducted. The fracture propagation tests of X100 or X120 under high pressure revealed that the existing models of arrest energy prediction failed to predict the arrest energies. By careful investigations of the test results, it is found that the failure in prediction is mainly due to the uncertainty of crack velocity curve prediction. On the other hand, accuracy of predicted gas decompression curve is relatively high even in the case of high pressure condition. Experimentally, the arrest energies have been determined by full-scale fracture propagation tests with increasing toughness arrangement. Different from actual pipeline, extremely low toughness pipe has been employed in crack initiation pipe with intention of getting steady state propagation. However, arrestability of pipe might be underestimated in the increasing toughness arrangement test as the initial crack velocity increases. Together with recalibrated crack velocity curve, Sumitomo model (HLP method with Sumitomo’s crack velocity curve) predicts that even toughness arrangement, which is the case of real pipelines, could arrest the propagating shear fracture in high pressure gas pipelines by X100.Copyright © 2008 by ASME