内視鏡的乳頭切除術にて治療した十二指腸乳頭部癌の1例

Adenocarcinoma of the Papilla of Vater Resected by Endoscopic Papillectomy, Report of a Case

要旨　患者は58歳，男性．1996年12月，人間ドックの胃X線検査で粘膜模様の異常が疑われ，精査目的にて来院した．上部消化管内視鏡検査を施行した際，十二指腸主乳頭の開口部隆起内に限局して，発赤を伴う顆粒状変化を認めた．生検の結果は高分化型腺癌であった．逆行性膵胆管造影は異常所見を認めなかった．術前に管腔内超音波検査を施行して，病変はOddi筋を越えず，乳頭部胆管および乳頭部膵管への進展所見を認めないことから，十二指腸乳頭部早期癌と診断した．患者の同意の下，1997年2月26日，内視鏡的乳頭切除術により治療を行った．現在まで遺残再発の徴候はみられていない．

　A 58-year-old male who was suspected through upper gastrointestinalgraphy of having a gastric mucosal abnormality, visited our hospital on December 11, 1996. Duodenoscopy revealed a reddish tumor with granular change in the papilla of Vater. Histological diagnosis of biopsy specimens was adenocarcinoma. ERCP disclosed abnormality neither of the vaterian bile duct nor of the pancreatic duct. Intraductal ultrasonography (IDUS) revealed a hypoechoic tumor-like lesion in the vaterian common duct but no tumor infiltration of the vaterian bile duct or the pancreatic duct. We performed endoscopic papillectomy with the patient's informed consent and the tumor was resected without complication. Macroscopic view of the resected specimen showed an exposed tumor in the papilla of Vater, measuring 5 X 4 mm in diameter. Histologic findings disclosed well differentiated tubular adenocarcinoma of the papilla of Vater, limited to the Oddi sphincter. The vertical margin was positive. Twenty four months after papillectomy there is no sign of recurrence. IDUS with high resolution images, which can demonstrate the duodenal papillary region in detail; is useful for the determining the indication for endoscopic papillectomy.