ガイド方式による迅速十二指腸挿管法―──低緊張十二指腸造影法のために──

Rapid Duodenal Intubation Using the Guide Wire

　低緊張十二指腸造影法に際しゾンデ挿入の繁雑さを避けるためtubelessの方法が考案されているが，しかしゾンデを使用した方がよりよいレントゲン像を得る場合が多い．そのための迅速な十二指腸ゾンデの挿入法については，既にいくつかの記載がみられる．その主なものとして乗用車のスピードメーターのケーブルをガイドにする方法^1)～3)や，選択的動脈撮影に用いられるMullerのguide systemを利用する方法⁴⁾などをあげることができる．しかしスピードメーターのケーブルはガイドとして用いるのにかなりの難があり，また後者の方法も操作が繁雑すぎるきらいがある．われわれの方法はそれらのアイデアをかりたものであるが，操作がきわめて簡単であり，多くの症例で十二指腸へのゾンデの挿入は1～5分で終了することができる．以下にその方法についてのべる．

　Rapid intubation with the duodenal tube is described by the combind use of a silicon-tube and a guide wire for KIFA “yellow” catheter employed in the Seldinger's method. For such examination as hypotonic duodenography a most effective result is achieved by our procedure. The point of instrumentation is to introduce the guide wire with the hard end foremost into the tube and then to let the patient swallow it as far down as near the cardia. Next, under x-ray TV fluoroscopy the tube is lowered to the distal part of the gastric body or to the pyloric antrum. At this point only the guide wire is taken out of the tube for once, and the other end of the guide wire with a soft tip is now introduced into the tube. By lowering the tube then, any part of the duodenum can now be reached at will with the olive. A concrete procedure is described here, with some comments on the course of the tube as it passes through the pyloric canal.

　Except for cases of cascade stomach, the time needed for successful insertion of the tube into the duodenum is 30 seconds to 8 minutes, with the mean time 4 to 5 minutes.

　Our experience show that in 70 per cent of cases the tube was introduced into the duodenum in 1 to 5 minutes.