膵の形成異常

Anomalies of the Pancreas

要旨　膵の複雑な発生過程から生ずる膵ならびに膵管系の形成異常を示す症例が近年膵の形態学的診断法の進歩により，徐々に認められてきている．従来から認められた輪状膵に対しては，ERCPにより膵管の走行を明らかにすることができるようになり，膵管の形成異常としての背側膵管と腹側膵管の非癒合（略して膵管非癒合）も副乳頭からの造影法の進歩により，診断が可能となり，膵管非癒合例の中に膵炎を示すものがあって，膵炎診断のうえで欠くことができないものになっている．また，背側膵管に発生した膵癌の診断に当たって，副乳頭からの造影が必要である．まれであった膵体尾部欠損症も膵検査の進歩により徐々に認められてきている．膵の診断に当たって，膵および膵管の形成異常に基づく病態を考慮することが重要である．

　Cases which indicate anomaly of development of the pancreatic duct system and pancreas which generate from complex occurrence process have gradually come to be recognized, due to recent advances in morphological diagnosis of the pancreatic disease. For annular pancreas which has been recognized so far, the branching out of the pancreatic duct was made evident by the ERCP (endoscopic retrograde cholangio-pancreatography).

　Also the un-fused dorsal and ventral pancreatic ducts (abbreviated as, the un-fused pancreatic duct), both anomaly of development of the pancreatic ducts, are now possible for diagnosis due to progress in pancreatography from the minor papilla. This has also become indispensable for diagnosis of pancreatitis which sometimes occur.

　Moreover, for diagnosis of pancreatic cancer which occurs in the dorsal pancreatic duct, pancreatography of the minor papilla is necessary. The very rare defect of the pancreatic body and tail has also gradually come to be recognized due to improvements in pancreatic examination.

　In the diagnosis of pancreatic disease, it is important that pathophysiology based on anomaly of development of the pancreas and pancreatic duct be taken into consideration.