黄疸のない早期乳頭部癌の1例

A Case of Early Carcinoma of the Papilla of Vater without Jaundice

　十二指腸乳頭部病変の診断能は，十二指腸ファイバースコープ，内視鏡的逆行性胆膵管造影法（Endoscopic retrograde cholangiopancreatography，以下ERCP）の開発以来，飛躍的進歩をみた^1)～6)．十二指腸乳頭部癌の報告もそれを契機に増加したが，まだ多くは黄疸を主徴として発見されたもの^7)～10)で，黄疸もなく，乳頭部に限局した早期癌の報告例はまだ稀有である．

　最近われわれは黄疸のない，乳頭部癌を術前診断し，根治手術を施行した早期癌と考えられる症例を経験したので，若干の考察を加え報告する．

症　例

　患　者：T. I.　45歳　家婦

　主　訴：心窩部痛

　既往歴・家族歴：特記すべきことなし

　現病歴：1975年5月頃より心窩部鈍痛，左背部苦痛あり，某医受診し，胆囊と胆管が腫れているといわれ，薬物療法を受け，自覚症状は治癒した．同年12月末に再び同様症状が出現し，同医を訪れ，当院での精密検査を勧められて，1976年1月24日当院第1内科を受診した．

　A 45-year-old woman was admitted to our hospital on February 20, 1971, for check-up because she had complained of dull upper abdominal pain. Intravenous cholangiograms before admission showed slight dilatation of the common bile duct (Fig. 1). The results of the preoperative laboratory studies are summarized in Table 1 and 2. Abnormal laboratory data were as follows; a sedimentation rate of 30 mm/hr.; minimal leucocytosis; and slight elevation of LAP (leucine aminopeptidase) and γ-GTP (γ-glutamyl transpeptidase). A glucose tolerance test showed a mild diabetic type. By virtue of hypotonic duodenography (Fig. 2), duodenofiberscopic examination (Fig. 3) and endoscopic retrograde pancreatography (ERP) (Fig. 4), we made a diagnosis of an early carcinoma of the papilla of Vater. Microscopic examination also showed positive evidence for carcinoma. Radical pancreatoduodenal resection (Whipple's modification) was performed on March 11, 1971. At operation, there was no metastasis to the regional lymph-nodes or pancreas.

　Resected tumor was localized at the papillary region, measuring about 15 X 15 X 13 mm in largest diameters, not invasive to the sphincter of Oddi (Fig. 9). Histologically, it was moderately well-differentiated adenocarcinoma (Fig. 10).