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Stomach and Intestine(Tokyo) Volume 9, Issue 12 （December 1974）

胃と腸 9巻12号（1974年12月発行）

Japanese English

今月の主題膵疾患の展望（2）―膵炎を中心に

主題

膵癌のX線診断―upper GI，特に低緊張性十二指腸造影 Diagnosis of Carcinoma of the Pancreas by the Radiologic Examination of the Upper Gastrointestinal Tract, Especially by Hypotonic Duodenography 中沢三郎 ¹ , 内藤靖夫 ¹ , 神谷直三 ¹ , 山瀬裕彦 ¹ S. Nakazawa ¹ , Y. Naito ¹ , N. Kamiya ¹ , Y. Yamase ¹ ¹名古屋大学医学部第2内科 ¹2nd Department of Internal Medicine, School of Medicine, Nagoya University pp.1519-1531

発行日 1974年12月25日 Published Date 1974/12/25

DOI https://doi.org/10.11477/mf.1403111702

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Abstract 文献概要
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　膵癌のX線診断は1931年Buttler¹⁾が，十二指腸係蹄の開大を指摘して以来，上部消化管X線撮影（upper GI），特に十二指腸造影から診断することが中心であった．最近になって，低緊張性十二指腸造影（HDG）^2)～10)各種胆道造影法，なかでも経皮経肝胆道造影法（PTC），逆行性膵胆管造影法（EPCG），血管造影法，シンチグラフィーその他の検査法の進歩により，膵癌の診断は飛躍的に向上したといえる，しかし，各種の検査法にもおのおの長所・短所があり，まだあらゆる条件を満たす検査法はない．

　そこでわれわれは，総合診断が必要であるとの立場から，各種検査法の組み合わせにより診断能を向上させてきた．しかしながら，対象患者に全ての検査をすることは実際上不可能であり，日常診療においては，多数の患者に容易に実施でき，しかもかなりの精度をもって膵癌発見の糸口となりうる検査法がまず必要となる．これらの条件を満たすものの1つに，上部消化管X線撮影がある．

　Hypotonic duodenography (HDG) has been performed in 53 cases of carcinoma of the pancreas (33 cases in the head and 22 in the body and tail) out of 60 such cases encountered from January 1969 to July 1974. On the basis of the results obtained, we have evaluated diagnosis of pancreatic cancer by means of HDG together with its diagnostic capability.

　1. Cancer was accurately diagnosed in 18 cases (54 per cent) among 33 cases of carcinoma of the head, and in 9 caces (45 per cent) among 20 of that of the body and tail. When cancer cases suspected as such by HDG were included, diagnostic capability of HDG rose as high as 80 per cent (23 cases) in carcinoma of the head and 75 per cent (15 cases) in that of body and tail.

　2. Abnormal findings detected by HDG, although not directly contributory to the accurate diagnosis or to suspicion of pancreatic carcinoma, were seen in 91 per cent in carcinoma of the head and 90 per cent in that of the body and tail.

　3. By combining HDG, various cholecystographic measures and EPG, we wer able to diagnose pancreatic carcinoma in all of 60 cases.

　4. Diagnostic capability of HDG can be heightened and the time needed for accurate diagnosis can be shortened if cholecystograrhy and EPG be co-employed after the slightest change detected by HDG has been well looked into.

　5. Of 22 cases of cancer of the body and tail, abnormal findings were seen in only the pars horizontalis of the duodenum in 8 cases and only in the duodenojejunal flexure in 4.

　6. The above results suggest that in conducting upper GI series duodenography and above all HDG is necessary and it is important to visualize the duodenum as far distal as the duodenojejunal flexure.