重複十二指腸主乳頭―内視鏡で観察した10症例について

A Study on the Duplication of the Duodenal Papilla: Ten cases diagnosed by endoscopic observation

　膵・胆管の開口様式に関しては，古くから剖検例を中心に詳細な検討が行なわれ，いくつもの分類がなされている^1)～8)．このvariationに富んだ膵・胆管の末端が，主として十二指腸主乳頭（以下単に乳頭）に開口しているわけであるが，実際には内視鏡的に開口形態を厳密に分類することは，いくつかのtypeを除くと非常に困難である．その理由は乳頭の内視鏡的形態が，機能的な運動，挿鏡操作による刺激，観察時の条件などによって大きく左右されるからであり⁹⁾，また剖検時に観察した形態が必ずしも機能をもっている生体の状態を忠実にあらわしているとはいえないからである．

　このように生体における膵管・胆管の開口形態を検討するには多くの問題があるが，最近，選択的な膵・胆管造影の経験が増すにつれ，この点における知識も増大してきた．特に，ある特殊な開口様式をもつ乳頭では，内視鏡的にもその形態を検討することが可能であると思われる．

　During endoscopic pancreatocholangiography (E.P.C.G.), we have sometimes experienced embryological variations. Among them, we have remarked about those cases which were suspected of having two main duodenal papilla (duplication of the duodenal papilla or double papillae).

　Up to now, we have experienced 10 cases of duplication of the duodenal papilla, the frequency of which was 0.61%. These two papillae were longitudinally arranged in all cases (longitudinal type). The biliary duct could be opacified only through the oral papilla. On the contrary, the pancreatic duct was visualized through the anal papilla in 8 cases out of 10. The anomalous pattern of the pancreatic and biliary ducts was seen only in one case, in which the Wirsung and the Santorini ducts were not connected. Among the cases of duplication of the duodenal papilla, the accessory papilla was endoscopically confirmed in 3 cases. The accessory pancreatic duct was observed in 5 cases on the X-ray film. The underlying diseases of the duplication of the duodenal papilla were gallstone in 7 cases, cholecystitis in 1, chronic gastritis in 1, and diabetes in 1. As mentioned above, the differentiation of the duplication of the duodenal papilla from the choledochoduodenal fistula, which was located on or very near the duodenal papilla, contains a basical question about the existence of such a condition as duplication of the duodenal papilla.