内視鏡的膵管造影―膵癌を中心に

Retrograde Pancreatography: with emphasis on carcinoma

　比較的早期の膵癌の診断は非常に困難であり，症状，臨床検査成績，上部消化管X線検査等に診断された時には，すでに末期で切除不能であることが多い．

　逆行性膵管・胆道造影法は1968年McCune¹⁾により初めて報告され，翌年高木²⁾，大井³⁾⁴⁾らにより，臨床応用が可能となった検査法であるが，本法は膵癌の診断に極めて有力な手がかりを与えることが知られてきた．その診断能についても未だ限界が残り，切除可能な膵癌の発見には，なかなか到達しえない現状である．このことは逆行性膵管造影の診断能のみの問題でなく，初期の膵癌患者は無症状で医師を訪れることは多いが，症状が発現して来院した時には進行癌であるという本症の特性にもよると考えられる．

　Retrograde pancreato-cholangiography has been performed on 330 cases. And 27 pancreatic cancers were diagnosed by this method: They were classified into the following three categories, according to the findings of retrograde pancreatography.

　1) Stenosed type. Cases of this type are recognized as irregular, though comparatively localized, infiltrative stenosis in the major pancreatic duct. The distal portion of the stenosed part, depending upon its degree, is sometimes normal and considerable dilatation is often recognized, and sometimes with cystic, smooth dilatation.

　2) Tapering type. In this type the major pancreatic duct tapers gradually from a certain point showing irregular rigid form and becomes gradually narrow like a needle and finally being interrupted. And those portions are relatively diffuse and branch-ing are lacking in such portions.

　3) Obstructed type. In this type, the pancreatic duct shows obstruction of the main duct with irregular edge.

　In the stenosed type and obstructed types, it is necessary to inject a sufficient amount of contrast medium into pancreatic duct, because branchings are lacking or being interupted around the abnormal pancreatic duct.

　Chronic pancreatitis sometimes has resembling findings of stenosis or obstruction of main duct.

But in cases of chronic pancreatitis diffuse changes in the duct are recognized by alternating stenosis and dilatation, and dilatation looks smooth relatively.

　In cases of obstructed type, pancreatolithiasis is present and obstructed protion showed no irregularity. On the contrary, in cases with pancreatic cancer stenosed or obstructed portions showed irregular margin and were lacking or obstruction of the branching around there.

　Tapering type finging of the main duct is characteristic of pancreatic cancer.

　In our 27 cases with pancreatic cancers, only one case complicated with insulinoma was resectable. It was noticed that early detection of the pancreatic cancer is as yet very difficult.