膵管胆道合流異常と胆道拡張症の上皮化生と発癌―治療面より

Anomalous Arrangement Disease of the Pancreaticobiliary Ducts in Congenital Biliary Dilatation from the View-point of Treatment

　主題の膵管胆道合流異常（以下，合流異常）が先天性胆道拡張症（以下，本症）にみられるという事実とその病因との関係について注目した学者は古くからあったことが文献¹⁾を参照すると明らかである．しかしながら，木積ら²⁾のすばらしい着想はわが国の学者にさえ関心を与えることはなかったようだし，多数例を経験することのできたわが国の学者は合流異常の存在を見ても見ぬ振りをしてあえて関心や興味を示さなかったことが，文献に示された写真に合流異常が明らかなのに何も言及していないことなどから推測される³⁾．

　この論文では，合流異常と関係した治療面について記述することになってはいるが，著者が本症と合流異常について研究してきた経過，文部省科学研究費の補助によってパンチカード方式で詳しく調査した全国集計の結果の一部，教室で経験した30症例中24例で検索できた胆道の病理組織学的所見を示し，治療法との関係に焦点をおきながら，本症の重要な点を簡潔に述べてみたいと思う．

　Congenital biliary dilatation is frequently associated with anomalous arrangement of the pancreaticobiliary ducts.

Including our own 30 cases, 432 cases have been collected from the cooperative institutions in Japan. There are 245 pediatric cases and 187 adult cases with 91 males and 341 females.

　Of these cases, detailed studies of anomalous arrangement of the pancreaticobiliary ducts have been done in 222 cases. All of our extensively examined cases of 17 had the anomalous arrangement. In the collected cases, 121 pediatric cases (87.4%) and 97 adult cases (78.9%) had the anomaly.

　In order to know the process to malignant changes, pathohistological study was done in 24 of our 30 cases. They are 11 pediatric cases and 13 adult cases. Grandular structures in the biliary duct wall were examined by stainings with H. E., PAS and alcian blue.

　From the studies, following assurnptions were made: due to the anomalous arrangement of the pancreaticobiliary duct, reflux of pancreatic juice into the biliary duct be inevitable, and the epithelial layer undergo destructive and productive changes with connective tissue embedding, regeneration, hyperplasia and even a metaplasia. With these processes over the years, malignant changes might ensue.

　Therefore, we would like to stress the importance of early diagnosis of congenital biliary dilatation, and early surgical intervention with interrupting reflux of pancreatic juice into the biliary duct and extirpation of the cyst followed by biliary reconstruction.