胆管系悪性腫瘍による胃十二指腸変化

ROENTGEN FEATURES OF CANCER OF THE BILIARY SYSTEM ON THE EXAMINATION OF THE UPPER GASTROINTESTINAL TRACT

はじめに

　膵臓疾患に際しての胃十二指腸変化についてはすでに多数の報告があり，広く知られている．一方胆管系悪性腫瘍における胃十二指腸の変化についての報告は比較的少なく，McConnell（1957），Khilnani（1962）らにより報告されているにすぎない．

　筆者らの教室では最近数年間に手術または剖検によって確認しえた胆管癌16例および胆囊癌14例の胃十二指腸造影フイルムを検討し，種々の知見を得たのでその概要を報告しようと思う．

　Frequently are overlooked the changes in the stomach and duodenum resulting from cancer of the gallbladdder or the common duct, although those from pancreatic cancer are well known.

　Films of the upper GI-tract were retrospectively observed in 16 cases of carcinoma of the common duct and 14 cases of carcinoma of the gallbladder proved histologically as such.

　The area most affected by carcinoma of the biliary tract is the first portion of the duodenum, that is, from the apex to the superior flex This segment is usually elongated, compressed and infiltrated by biliary malignancy on its superior and lateral aspects. The duodenal cap frequently shows a peaked configuration with flattening on the lateral aspect. The elongated post-apical portion of the duodenum is displaced somewhat medially so that it lies directly behind the duodenal cap. In contrast to carcinoma of the pancreas, the lateral or the anterior aspect of the first portion of the duodenum is involved rather than the medial or the posterior aspect. These changes are well demonstrated on the right anterior oblique or right lateral projection.

　Diagnosis of carcinoma of the biliary system is generally fairly difiicult both clinically and roentgenologically. However, roentgenologic changes described above, if present, may in the majority of cases often lead to a correct diagnosis.