十二指腸ファイバースコープを利用したVater乳頭部および膵頭部の経十二指腸的needle aspiration biopsy

Transduodenal Needle Aspiration Biopsy for Periampullary Lesions Using a Fiberduodenoscope

　Vater乳頭部や膵頭部の病変の診断法としてHypotonic duodenographyや十二指腸ファイバースコープによる内視鏡的観察および逆行性膵胆管造影法は手技的にもほぼ完成され，その進歩普及はめざましいものがある．しかしながら，乳頭部の腫大を呈する場合，乳頭部の炎症性腫大と膨大部癌とを内視鏡的観察のみで鑑別診断することは必ずしも容易でなく¹⁾²⁾，また，レ線上，膵頭部の腫大を認める場合にも，炎症性腫大と癌との鑑別診断が困難な症例も少なくない．このように鑑別困難で，かつ悪性病変が強く疑がわれる症例に対しては，開腹し術中生検によって確診をうるという努力が従来より払われてきた．

　術中膵生検に関してはincisional biopsyの限界が指摘されていらい，膵内の硬結を触知する部位に針を用いて生検を行なう方法（fine-needle aspiration biopsy）が赤司ら³⁾，Forsgrenら⁴⁾により，良好な診断成績を報告されているが，他方，非開腹的に膵組織を得る方法については詳細な報告をみないようである．

　Endoscopic observations of the papilla of Vater and retrograde pancreatography using a fiberduodenoscope are informative diagnostic procedures for disorders in the periampullary lesion.

　However, it is not always easy to differenciate inflammation of the papilla and malignancy in the submucosal layer of the papillary region because swelling and edematous protrusion of the papilla are observed in both papillitis and carcinoma of the ampulla of Vater.

　While pancreatography has seemed to be most effective in the diagnosis of carcinoma of the pancreas, it is pointed out the difficulty in differentiation between severe chronic pancreatitis and carcinoma of the pancreas.

　The purpose of this report is to elucidate the value of non-surgical needle aspiration biopsy in the diagnosis for periampullary lesions.

　Non-surgical needle aspiration biopsy of the periampullary region was made possible by passing a fine 26 gauge needle through the fiberduodenoscope into the duodenum and aspirating the tissues of the ampulla of Vater and the pancreatic head through the duodenal mucous membrane.

　The biopsy materials were fixed in 99.5% ethylalcohol and examined using Papanicolaou-stained smear and cell-block preparates.

　Histological diagnosis of carcinoma was established in all cases of carcinoma involving the ampulla of Vater and the head of the pancreas. The authors are convinced that this needle aspiration biopsy technique is of considerable help in making diagnosis of carcinoma of the ampulla of Vater and of the head of the pancreas and in differenciating the cause of the obstructive jaundice.