十二指腸乳頭部病変のX線診断

Radiographic Diagnosis of Lesions in the Duodenal Papillary Region

　十二指腸乳部頭病変をX線診断学の立場より考察するには，乳頭部の持つ特殊性を充分に理解しておかねばならない．即ち，乳頭部は解剖学的には，十二指腸側よりみれば，MASSであり，胆，膵管側よりみれば，SPACEである二面があり，また乳頭部病変は，単に乳頭部の病変にとどまらず，肝，胆道，膵と密接な関連を持ち，互に影響し合うことを理解し，十二指腸側，胆，膵管側，両者の相互関係を検討することが大切である．

　筆者は，乳頭部病変について，基礎的，臨床的な研究^1)～3)を進めて来たが，今回は，乳頭部病変で，現在，最も重要な課題である乳頭部癌及び謂ゆる乳頭炎に際し，十二指腸乳頭部像（乳頭部像と略す）および胆管像が如何に変化し，また両者がどのような関連で変化するかを検討し，報告する．

　In the past we have emphasized morphological specifity of the duodenal papillary region for the diagnosis of its lesions. It has double faces in that it is a “mass” seen from the duodenal side, while it is a “space” on the side of the bile duct. Its close connection with the liver, biliary tract and pancreas has also been stressed.

　In this paper are discussed papillitis and papillary cancer that represent two most important lesions in this area. X-ray depiction of the duodenal papilla and its cholangiographic expression together with the way how they affect each other are discussed as well from the basic and clinical standpoint.

　1. Radiographic feature of papillitis on the duodenal side is “swelling” of the papillary region, although differently affected by the types of the papilla, while its cholangiography is characterized by the stricture of the common bile duct in the papillary region with resultant dilatation the segment above it.

　2. “Swelling” of the papilla in duodenal radiography and its stricture in cholangiography arise from the same mechanism, probably caused by fibrosis of both the sphincter of Oddi and the submucosa in the common bile duct and also by hypertrophy of the sphincter of Oddi protruding into the duodenal lumen.

　3. In papillary cancer, abnormalities are found in both duodenal x-ray and cholangiography. However, as they are not always found simultaneously, we need to study them comprehensively.

　4. Findings specific to cancer of this area are seen in radiography either as ulcer (erosion) or irregular unevenness of the papilla and in cholangiography as its obstruction.

　5. In order to diagnose cancer of the papillary region in yet earlier stages, we need comprehensive approach to it not only from the side of the duodenum but also from that of the biliary and pancreatic ducts. Pathogenetic study of early papillary cancer is also essential.