内視鏡的膵液・胆汁採取とその診断的展開

A Review of Studies on Endoscopically Obtained Human Pure Pancreatic Juice and Bile

　内視鏡的純粋膵液および胆汁採取は，内視鏡的膵胆管造影が臨床の場に導入されて間もなく，神津および筆者によって始められた．

　純粋膵液に関する研究は，その後多方面にわたって発展の道をたどってきた．すなわち，①細胞診への応用，②CEA（carcinoembryonic antigen），POA（pancreatic oncofetal antigen）など膵癌の早期診断のための腫瘍マーカーの検索，③膵外分泌生理研究への応用，④膵外分泌機能検査への応用，⑤膵液の生化学的分析およびprotein plugの形態学的検討による慢性膵炎の病態生理に関する研究，⑥Protein plugの内視鏡的吸引除去による慢性膵炎の治療に関する研究，などが主たるものである．それと対象的に，純粋胆汁の生化学的分析に関する研究は極めて少ない．以下，過去10年間の内視鏡的膵液・胆汁採取に関する研究のうち，臨床に直接関係深いものを中心に述べる．

　Studies on pure pancreatic juice have developed in terms of cytodiagnosis; investigation of tumor mark-ers such as CEA, POA, Gamma-GTP, Cathepsin B and immunoglobulins; application to exocrine pancreatic function test; studies on secretory mechanisms of pancreatic juice; studies on pathogenesis and pathophysiology of chronic pancreatitis through the evaluation of viscosity, hydrolytic enzymes, enzyme inhibitor, mucoproteins, inorganic substances, lactoferrin, etc; studies on mechanisms of protein plug formation and its role in the evolution of chronic pancreatitis; studies on treatment of chronic pancreatitis by endoscopic elimination of protein plugs. Further studies are in progress, such as, on the effect of various drugs and substances upon the pancreatic secretion; relationship between exocrine and endocrine pancreatic secretion and so on. Studies on pure bile, in contrast, are dealt with in only a few reports: secretion of drugs and HBs AG; determination of bile acids and lipids. Therefore, further biochemical studies on pure bile should be performed with more enthusiasm.