小膵癌（2cm以下）症例―膵頭部癌6例の諸病像

Six Cases of Small Pancreatic Cancer

　1965年から1979年末までの15年間に京都大学第1外科で入院加療した膵癌は173例であり，この中で切除可能例は43例，切除率24.8％である．なおこの中に乳頭膨大部癌，胆道末端癌，十二指腸癌は含まれていない．これら切除例はすべて新鮮切除標本を用いて病巣の大きさを計測したが，このうち最大径が2.0cmもしくはそれ以下のものは6例であり，いずれも膵頭部癌であった．これらわれわれの切除した6例の小膵癌の諸病像を以下に記述する．

　We have encountered six cases of small cancer of the pancreas 2cm or less in the greatest diameter. They showed the following pathologic pictures.

　1. Three of these six showed the site of the lesion to be in the postem-superior area of the head of the pancreas, two showed that in the area of the main pancreatic duct, and the remaining one showed that in the antero-superior area of the head.

　2. Excepting one case, jaundice of various degrees was noticed. The mean time from the appearance of jaundice to the final resection of the lesion was 1.9 months.

　3. Subjective symptoms before the surgical operation were variegated, but jaundice in almost all cases accounted for the motive of the patients to visit the out-patient clinic. Among them, diabetic patients treated for a long time were included.

　4. Accurate diagnosis of pancreatic cancer in most cases was made by ERCP.

　5. All cases were resectable. In five cases was (lone total pancreatectomy. The Whipple procedure was made in one cases. In three cases was seen infiltration of the pancreatic capsular layer and in three metastasis of the lymph nodes was microscopically shown.

　6. A skip lesion was found in the tail in one case out of five that were histologically investigated in the entire length of the pancreas.

　7. The longest survival case was a patient who died of liver abscess four years and a half after the whole resection of the pancreas. The shortest one due to recurrence was 9. 1 months after the operation.