胆道末端部の機能診断―胆道末端部運動波型のコンピューターによる分析

Diagnosis on the Function of the Terminal Part of the Choledochus―Computed analysis of the wave of papillary movement

　胆道末端部の機能を正確に診断することは，生理学的ならびに病態生理学的にも極めて重要なことと考えられるが，方法論的に困難なこともあって，この方面の研究は比較的少ない．すなわち，主として外科領域において，術中に胆管内圧の測定や造影による所見^1)～3)，薬剤負荷による内圧の変動²⁾，活動電位の測定³⁾などによって行われているのがほとんどと言える．しかし，近年，非観血的方法として，RIも含めたX線学的方法⁴⁾や内視鏡を用いた方法⁵⁾⁶⁾なども報告されるようになった．

　著者らは，1974年に感圧素子装置を用いて内視鏡下にヒトの胆道末端部運動の測定に成功し⁷⁾，以後，症例を重ねることにより，胆道末端部機能が正常と考えられる症例では，胆道末端部は規則性を持った周期で，収縮弛緩運動を繰り返していること，それに対して胆・膵疾患を有する症例の胆道末端部運動は，周期，振幅に乱れを生じ，ときには全く周期性のみられない運動波型を示すものも存在することを報告した⁸⁾⁹⁾．

　We developed pressure-sensitive transducer appa-ratus to diagnose functional disorders of the terminal part of the choledochus and reported that patients with biliary or pancreatic disease tend to have increased incidence of its abnormal function by measuring their motility under the endoscopic examination.

　This time, to evaluate their abnormalities more objectively, we performed computed analysis of the waves of papillary movement on 35 patients with various disease.

　The results obtained were as follows ;

　In cases with normal function of the terminal choledochus, their mean cycle of the papillary movement was 5.9 sec., ranging 5.2 to 6.5 sec., and its average power was 2.9.

　On the other hand, if the function of the terminal choledochus was impaired, its power dropped less than 1.0 and their cycle was irregular. If its function was mildly to moderately impaired, the range of the cycle became wider as 4.8 to 10.1 sec., and maximum spectrum of the power dropped less than 2.0.

　Using the above our method, it became possible to express the degree of functional abnormalities of the terminal choledochus by objective measure, namely by using a graph consisting power and cycle.

　We also believe it is quite useful method only for clarifying pathophysiology of the terminal choledochus but also for clinical use.