膵・胆管合流異常で術後膵石の形成をみた例と膵管非癒合に鉤状部癌の発生をみた例の2症例

Follow-up Cases of Malformation of the Pancreatic and Biliary Ducts

要旨　膵・胆管形成異常は奇形であり，成人例においては直接病因となるよりは，病因的素因と考えられる．そのため，膵・胆管造影上は，像に変化をみないで経過する例がほとんどである．〔症例1〕は29歳女性で，総胆管の嚢腫状拡張を伴い，膵管末端の異常拡張部に非陽性膵石を認めた膵・胆管合流異常（CCC）であるが，嚢腫摘出術後7年目に陽性膵石を認めた．分流術が行われているため，膵石生成の原因は基礎疾患によるものか，手術によるものか明らかではない．〔症例2〕は79歳男性で糖尿病があり，膵管非癒合，そして腹側膵管の異常像から，腹側膵の慢性炎症と考えられた症例である．しかし，4年後に膵鉤状部に摘出不能な膵癌の発生をみた．この例では，むしろ初回検査時に膵癌の存在を見落としていたと思われる．

　Malformations of the pancreatic and the biliary ducts are anomalies of the ductal systems. When they are found in adult cases, they are not a direct cause of the diseases, but they might be an indirect cause or disposing condition leading to pancreatic and the biliary disorders. Their pancreato-biliary ductal systems usually, do not changed.

　Case 1 was a 29 year-old woman, who was operated on in 1976 after diagnosis of the anomalous connection of the pancreatic and the biliary ducts with cystic dilatation of the common bile duct. Seven years after resection of the cystic dilatation of the common bile duct and removal of the translucent pancreatic stone, positive pancreatic stone is found at the same position where translucent pancreatic stone was located. In this case, formation of the positive pancreatic stone would be due more to the previous operation than to the original disorder.

　Case 2 was that of a 79 year-old man, who had suffered for a long time from diabetes. He was examined by endoscopic pancreato-cholangiography and non-fusion of the ventral and dorsal pancreatic duct systems was confirmed. Pancreatic cancer was found four years later at the uncinate section. In this case, tumor would have existed at the first examination and carcinogenesis might have no relation to the anomalous pancreatic ductal system of the patient.