十二指腸乳頭部癌の診断

Diagnosis of Carcinoma of the Papilla of Vater

要旨　最近経験した十二指腸乳頭部癌16例の診断について内視鏡を中心に報告した．臨床症状は，黄疸が16例中10例（62.5％）と高率に認められ，腹痛，発熱，黒色便が各1例で，無症状例は3例であった．入院時血液生化学検査はγ-GTP値，次いでALP値，総ビリルビン値の異常が認められた．生検診断率はERCP下生検で癌陽性と診断しえたものは12例中10例（83.3％）で，悪性所見が得られなかった2例の肉眼型は露出腫瘤型，組織型は中分化型管状腺癌であった．一方，PTCS下生検で癌陽性と診断しえたものは7例中5例（71.4％）で，悪性所見が得られなかった2例の肉眼型は腫瘤潰瘍型，組織型は高分化型管状腺癌であった．十二指腸乳頭部癌におけるEUS，細径超音波プローブの進展度診断能はそれぞれ十二指腸浸潤は89％，100％，膵臓浸潤は78％，90％であり，EUSなど従来の診断法に細径超音波プローブを加えることで，より正確な進展度診断が可能となった．

　Clinical symptoms, blood chemistry test, biopsy and diagnosis for evaluation of the depth of invasion in 16 cases of carcinoma of the papilla of Vater were described. Jaundice was the most predominant symptom on admission accounting for 10/16 cases (62.5%). Blood chemistry test revealed a high incidence of abnormality of γ-GTP (100%) followed by ALP (93.8%) and total bilirubin (81.3%). As for the diagnostic rate by biopsy, cancer tissues were obtained in 10/12 cases (83.3%) with endoscopic procedure, and in 5/7 cases (71.4%) with biopsy from the terminal bile duct. Diagnostic accuracy of invasion by EUS and miniature ultrasonic probe was 8/9 cases (89%) and 10/10 cases (100%) respectively for duodenal infiltration, and 7/9 cases (78%) and 9/10 cases (90%) respectively for pancreatic infiltration. The diagnosis potential was particularly excellent in early carcinoma of the papilla of Vater. Use of miniature ultrasonic probe, in addition to conventional diagnostic methods such as EUS, made possible progress diagnosis with higher accuracy. In the early diagnosis of carcinoma of the papilla of Vater, careful attention should be paid to the presence of abnormalities of the biliary-pancreatic duct and of the duodenal papilla during performance of US, GIF and UGI.