十二指腸乳頭部癌の画像診断―胆膵管からのアプローチ

Carcinoma of the Duodenal Papilla Diagnosed by Cholangiography, Pancreatography and Such New Image Procedures as PTCS, PPD and EUS

要旨　68例の十二指腸乳頭部癌切除例（早期21例，進行47例）の検討から，68例中37例54.4％で癌腫が管内性に十二指腸壁外胆管内に浸潤し，68例中10例14.7％で管内性に膵頭部主膵管内へ浸潤しており，乳頭部癌の診断には膵胆管側からのアプローチが必要であることがわかった．胆管側からのアプローチはPTC，PTCS，胆管二重造影があり，他疾患との鑑別や胆管側への浸潤を診断できた．膵管側からのアプローチはPPD，副乳頭造影を含むERPによる膵管造影があり，高率に膵管像が得られ膵側への進展度診断が可能であった．EUSは腫瘍と十二指腸壁，胆膵管，膵実質を描出できるため腫瘍の浸潤が診断でき，また，転移リンパ節の指摘も可能であった．

　Eighty-three cases of carcinoma of the duodenal papilla treated in our hospital were reviewed, with par-ticular attention given to the spread of carcinomas into the bile duct and pancreatic duct. Of the 68 cases in which carcinomas were resected, invasion into the bile duct was found in 37 (54.4％), invasion into the pan-creatic duct in 10 (14.7％) cases. Two cases had deep cancer extension intraductually in the body of the pancreas. These results indicate that examinations of the bile duct and pancreatic duct are essential. As to the bile duct approach, PTC, PTCS and PTDCC were useful for differential diagnosis as well as for diagnosing infiltration of carcinoma into the bile duct. With respect to the pancreatic duct approach, PPD and ERCP including cannulation into the minor papilla were recently performed in 20 patients, of whom pancreatographies were obtained in 16 (80％). These pancreatographic findings showed that spread of carcinoma into the pancreas could be diagnosed precisely. In order to diagnose extension of carcinoma, EUS was performed in 13 patients with the stage of carcinoma being thereby correctly determined.