小児に内視鏡的膵・胆管造影を施行しえた興味ある症例

Endoscopic Retrograde Cholangiopancreatography in Children

　内視鏡的膵・胆管造影法は1969年，大井¹⁾，高木ら²⁾の報告以来，器具の改良，手技の向上に伴い広く発展普及した．さらに術後胃症例³⁾などの特殊例にも本法の施行は可能となり，現時点では膵臓，胆道疾患の重要な検査法となった．本法は非観血的な検査法であるため，その検査対象は若年者から高齢者まで安全に施行可能であるが，いまだ幼小児に施行された報告は数少ない．今回，著者らは本法を小児例に施行し，興味ある知見を得たので報告する．

〔症例1〕

　患　者：6歳　男性

　主　訴：上腹部痛

　家族歴：特記すべきことなし

　現病歴：物心ついた頃より，時々食後に腹痛を訴えるすぐに軽快するため放置していた．1973年5月（4歳時），嘔気，嘔吐を生じ脱水状態となり某院に入院した．発熱，黄疸は認めていなかった．入院後，加療にて症状消失し5日間で退院した．その後も時々，軽度の腹痛があったが保育園を休まず登園していた．1975年11月24日，強い右上腹部痛と嘔吐をきたし某院に入院した．加療により症状は消失したが，1975年12月10日精査のため来院した．

　In recent years, endoscopic retrograde cholangiopancreatography (ERCP) has become the most valuable diagnostic method for pancreatic and biliary diseases. However, successful ERCP in children has been very scarce. This report persents the ERCP performed in two children.

　One was a 6-year-old boy weighing 19 kg. ERCP was successfully performed using JF-B2 under general anesthesia and both biliary and pancreatic ducts were clearly visualized. The diagnosis of congential choledochal cysts was established.

　The other was a 13-year-old boy. ERCP showed a partial stenosis and dilatation of the pancreatic duct. Operation disclosed tumorous lesions involving the duct system. Hystopathological diagnosis of the tumor was Burkitt's lymphoma developing retroperitoneally.

　In our opinion ERCP is the most suitable method for the diagnosis of congenital choledochal cyst. The abnormal confluence of the bile and the pancreatic ducts associated with this disease can be observed clearly by this procedure. The study of the abnormal connection of the both ducts will be useful in solving the pathogenesis of congenital cysts and determining the method of operation.

　When duodenofiberscopy will be more improved ERCP will also be possible in the new born infant. Then the differential diagnosis of congenital biliary atresia and other congenital failures in infants causing jaundice will be established endoscopically.