慢性膵炎長期経過観察中に発症した膵石症の1治験例

A Case Report of Pancreatic Stone Developed during Long Follow-up of Chronic Pancreatitis

　膵石症は比較的まれな疾患とされており，近年，慢性膵炎に対する関心がたかまり，内視鏡，X線など診断技術の進歩とともに報告例が多くなっている．その病因，臨床像，生成機序および進展過程が解明されつつあるが，まだ不明な点が多い．最近，われわれは，ERCP，PS testで確診したアルコール性慢性膵炎の経過観察中に3年後に膵石症となった1例を経験したので，文献的考察を加え，報告する．

　The mechanism of formation of the pancreatic stone is not fully understood. It has been generally accepted that the pancreatic stone occurs as a sequela of chronic pancreatitis. However, how long a time is required for the formation of a pancreatic stone can not be definitely stated. Recently, we experienced a case of pancreatic stone during long follow-up of chronic pancreatitis and it is reported here.

　The patient, a 28-year-old man, began to suffer from epigastralgia since the age of 20. He had a long history of heavy drinking since the age of 15. He had been first admitted to our hospital in 1974 because of epigastralgia and nausea. Chronic pancreatitis was diagnosed by pancreozymin-secretin test and endoscopic pancreatic-cholangiography. Owing to continued drinking, the pain got no relief despite medical treatment. As a method of follow-up, we took plain films of the abdomen periodically and pancreatic stones were diagnosed about three years after the diagnosis of chronic pancreatitis. On admission in 1977, P-S test showed decrease of total volume, maximal concentration of HCO₃^- and amylase output. ERCP demonstrated the stones within the dilated pancreatic duct. The patient had underwent surgical intervention on account of intractable pain. The postoperative course was smooth.