膵炎の診断と治療―急性・慢性を含めて

Diagnosis and Treatment of Pancreatitis, Acute and Chronic

　与えられた課題が非常に広範にわたるので，急性あるいは慢性の膵炎の診断と治療について概括的に述べ，さらに，現在のわれわれが当面している問題点について触れてみたい．

急性膵炎について

　われわれがかつて急性膵炎の治療に関する考察を試みたさい，本症の治療を考える上にはいくつかの基本的な問題を踏えねばならぬことを指摘した¹⁾．その中の1つは，本症のように急激に変化する病状に対しては治療を一括して論ずるのでなく，病期に対応してこれを考慮することが望ましいという点であった．これを診断の立場から眺めると，急速に変遷する病態を正確に把握して，治療の指針をたてるのに役立つ診断法の確立がつよく望まれる．いいかえると，必ずしも急性膵炎の診断が確定してから治療が始まるのでなく，患者に接触すると同時に治療が開始され，両者は併行して進められることが少くない．この間の消息を表1で模式的に示す．

　Diagnosis and treatment of acute and chronic pancreatitis are summarily described along with some problems we are confronted with.

　As acute pancreatitis shows sudden changes in signs and symptoms, appropriate measures must always be taken to promptly meet the ever-changing situation instead of commencing treatment after the diagnosis has been definitely established. It is therefore important to evaluate properly the information obtained. Simple diagnostic techniques such as biochemical examination of the blood coupled with accurate assessment of signs and symptoms are of great significance in the diagnosis of acute pancreatitis to which more advanced and intricate diagnostic techniques cannot be applied actively.

　Diagnosis of chronic pancreatitis is tentatively summarized in the clinical criteria laid down by the Japanese Society of the Study of Pancreatic Diseases. However, as these criteria are not provided for in details, we have set forth the problems to be taken into due account in their practical application.

Diagnostic possibility of slight pancreatic disorders which are excluded from the above-mentioned criteria has also been referred to, and several attempts at it has been introduced.

　Although findings of endoscopic pancreatography are dealt with in the afore-mentioned criteria as belonging to those of questionable cases, we attach proper value to it. At the same time, we have referred to the importance of comprehensive diagnosis including the results obtained by this procedure.

　Finally, we have laid stress on the necessity of long-term follow-up of cases with suspected pancreatitis.