十二指腸乳頭部病変の内視鏡診断―内視鏡像と生検所見ならびに膵・胆管像

Endoscopic Diagnosis of Lesions in the Papillary Area of the Duodenum: Endoscopic and biopsy findings and pancreatocholangiogram

　ファーター乳頭は胆管および膵管の十二指腸開口部で，胆道疾患および膵疾患と乳頭の関連が古くから論じられて来たことは衆知のことである．しかし，十二指腸ファイバースコープの開発以前は，非観血的に乳頭部を直接観察することは不可能であったが，十二指腸ファイバースコープの開発^1)～3)以来，その改良と手技の進歩により内視鏡的に乳頭部を観察することが可能となり^4)～8)，直視下に生検も行なわれ^6)9)～11)，さらにファイバースコープを用いた逆行性膵・胆管造影も試みられるようになった^9)12)～24)．

　私どもは乳頭部の内視鏡ならびに生検所見を検討し，膵・胆道疾患とそれらとの関連，とくに内視鏡的膵・胆管像との関連を追求し，いささか知見を得たので報告し，考察を加えた．

　Fiberduodenoscopy with JF type B was performed in 1,900 cases clinically suspected to have diseases in the duodenum, pancreatic or biliary systems. Biopsy of the papilla of Vater in 543 instances and endoscopic pancreatocholangiography (EPCG) in 310 cases were studied.

　Shape of the normal papilla of Vater was endoscopically classified into four groups; hemispherical, he-miellipsoid, flat and special types. The hemispherical type was most commonly seen.

　Shape of the orifice of the pancreatic and biliary ducts was classified endoscopically into four types; round, puckered, slit-like and elongated.

　Marked swelling, redness, visible dilated blood vessels in the submucosal layer, edema, bleeding, erosslon, ulcerations, granular, nodula and cauliflowerlike appearances of the papilla of Vater were listed as endoscopical, pathological findings of the papilla as well as a markedly swollen longidudinal fold of the duodenum in the papillary area.

　Inflammation at the papilla was usually demonstrated by biopsy in the cases in which endoscopic findings of inflammation were observed in the papillary area, and a correlation between the both findings was observed in the majority of the cases studied.

　Endoscopic and biopsy examination of the papilla of Vater is one of the most reliable methods to detect a malignancy of the papilla.

　Pressure of injecting dye in the EPCG was controlled with a manometer developed by us.

　Inflammation at the papilla of Vater in biopsy and endoscopical, inflammatory findings in the papillary area were observed in the majority of the cases revealing inflammation in the pancreatic and biliary ducts with chronic pancreatitis, pancreatic carcinoma, stone of the common bile duct, carcinoma of the gall bladder and the common bile duct, and liver tumor diagnosed by EPCG.

　It seems that the inflammatory findings in the papillary area would be signs suggesting the presence of inflammation in the pancreatic and biliary tracts.