先天性総胆管拡張症と膵・胆管合流異常

Anomalous Arrangement of the Pancreaticobiliary Ductal System

　先天性総胆管拡張症（本症と略す）の形態的特徴として，胆道末端部と膵管の合流形態が正常な発生例とは異なる，いわゆる“膵・胆管合流異常”が近年注日されてきた．そして，“膵・胆管合流異常”が本症における胆道拡張の原因ではないかとする意見もある¹⁾．われわれも早くから本症における胆道末端部の形態に注目して本症の形態的特徴との関係を検討してきた．その結果，“膵・胆管合流異常”は本症に高頻度に認められるが，必ずしも全例に合併するものではなく，また胆管の拡張が伴わなくとも“膵・胆管合流異常”がみられる症例を経験した．

　Congenital cystic dilatation of the common bile duct is regarded as a disease which shows localized dilatation of the biliary ductal system including the common bile duct as its morphologic feature. Recent development of the biliary ductal examination has revealed that usually the disease also Shows the join of the distal choledochus to the main pancreatic duct with narrowing, i.e. the anomalous arrangement of the pancreaticobiliary ductal system. Some papers reported that this anomalous arrangement was one of the causes of the dilatation of biliary ductal system in congenital cystic dilatation of the common bile duct.

　We found, however, two patients with congenital cystic dilatation of the common bile duct out of 241such patients had separate orifice of the bile duct and the pancreatic duct. In these two patients duodenal contents easily passed into the biliary ductal system and soon flew back to the duodenum on standing in barium study. Generally both of them had normal liver function with no fever.

　On the other hand, we had experienced that a 48-year-old woman with normal biliary ductal system had the anomalous arrangement. Papilloplasty was performed in this patient owing to the symptoms of relapsing acute pancreatitis. After the operation the complaints were successfully alleviated.

　Judging from these three cases we have come to the conclusion that congenital cystic dilatation of the common bile duct is usually accompanied with the anomalous arrangement of the pancreaticobiliary ductal system and yet the occurrence of “dilatation of the bile duct” is different from that of “anomalous arrangement of the panceaticobiliary ductal system” on the development of biliary ductal system.