上腹部腫瘤と血管造影

Tumors in the Upper Abdomen and Celiac Angiography

　上腹部腫瘤の放射線学的診断法には，従来から腹部単純撮影，上部消化管検査，胆囊造影，後腹膜気体造影，気腹造影，腎孟造影などが副作用が少なく，実施手技が容易な検査法として用いられてきた．最近になって，これらの検査法に加えて放射性同位元素を用いたスキャンニング，超音波診断法，経皮胆管造影法，膵管造影法，血管造影法が開発され臨床に広く応用されてきている．

　血管造影法の腹部腫瘤診断における特徴は，病巣内の血管のパターンから腫瘤内部の状態を知り得ることである³¹⁾³⁴⁾．従来の放射線学的検査法は，腫瘤周囲の状態，周囲臓器との関係から診断に至る，いわば間接的診断法であるが，血管造影法は腫瘤の内部の状態まで観察できる直接的診断法であり，質的診断，鑑別診断が可能という長所を有している．本稿ではわれわれが実施した約3000例の腹部血管造影法の経験をもとにして，上腹部腫瘍に対する意義，読影法などについて解説する．

　For radiographic diagnosis of tumors in the upper part of the abdomen we are provided with various methods including plain exposure and upper G-I series. For all that, they remain indirect diagnostic procedures, arriving at a diagnosis only through the study of areas neighboring on a given neoplasm or its relationship to the adjoining viscera. On the other hand, celiac angiography affords us more information in qualitative diagnosis of a tumor not only about the regions around it or their relationship to the neighboring organs but also about how it is within the tumor itself through visualizing abnormal courses of blood vessels around it or even those within it.

　On the basis of about 3,000 cases of celiac angiography performed by us so far, we have described in this paper its techniques and the regular sequences in putting it in practice, together with its significance in the diagnosis of masses in the upper abdomen. How to interprete the findings obtained thereby has also been presented along with its importance in qualitative diagnosis of those neoplasms. Special reference has been added to tumors in such organs as the liver, pancreas, spleen, biliary tract, greater omentum, kidney, adrenal gland, rectum and those in the retroperitoneal cavity, with some comments not only on the interpretation of the findings obtained from them but on the diagnostic significance as well in reading them correctly.

　Celiac angiography is not completely free from untoward complications, and it is especially emphasized here that this procedure be done only at the hands of experts in it.