持続する腹部鈍痛を伴った膵石症の1例

A Case of Pancreatolithiasis with Persistent Dull Epigastric Pain

　近年膵臓病への関心がたかまり，わが国の慢性膵炎もかなりの頻度で存在することが示されている¹⁾．そしてその成因の分析や診断技術の向上と同時に，経過や予後の観察にも興味がもたれ始めた²⁾．

　われわれは手術を拒否され6年余にわたり内科的に経過を追った膵石症例を経験したので報告し，その問題点をとりあげてみた．

　A 48 years old man, a heavy drinker, was admitted to the hospital for diabetes mellitus in 1972 and for epigastric pain in 1973. The diagnosis was pancreatolithiasis and various pancreatic examinations were conducted.

　In the caerulein-secretin test, depression of all three factors (volume, maximum bicarbonate concentration, and total amylase output) was seen. In the pancreatic function diagnostant (PFD) test, 12.2 percent of PABA was found in six hours urine. The amylase content of the blood was low and in the isozyme, the disappearance of Band Ⅲ of the pancreas was seen. The ERCP (endoscopic retrograde cholangiopancreatogram) showed the enlargement and beadschain change of the pancreatic duct.

　Because the patient refused to be operated on, various internal treatment including the use of drugs against pancreatic proteinase were conducted. But due to continued epigastric pain, analgesics were to be used.

　This case led us to realize the indication of a welltimed surgical treatment for chronic pancreatitis. And in the amylase isozyme of the duodenal juice of this case, bands showing different movement tendencies from those of the pancreas appeared, and the in vivo denaturation of the pancreatic amylase was suspected.