胆路系疾患に於ける十二指腸大乳頭部のX線学的・臨床的研究
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概要
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The Duodenum, especially, the Papilla of Vater proves various responsed pathologic changes in the diseases of biliary system. However, a cast of the stomach sometimes superimposes above the duodenal loop, therefore the duodenum obscures in the routine gastrointestinal examination. The auther studied the papilla of Vater by isographic examination of the duodenum and then observed clinical symptoms, laboratoric findings and operative informations of various diseases of the biliary system. The results are summarized as follows: (1) In the normal duodenum an incidence of the major papilla on x-ray examination reveals 58.6% (34 in 58 cases), an average size shows 0.9cm in width and 0.6cm in length on a lateral film (20 cases), and on the other hand there is 1.3 cm in width and 0.7 cm in length on a sagittal, picture. (2) Observed cases of diseases of the pancreatic and biliary system are 20, these are 2 cases of pancreatitis, 5 of cholecystitis, 10 of cholelithiasis and 3 of choledocholithiasis. In 8 cases of these present an enlargement of the papilla of Vater and in 12 recurrence of barium meal into the bile duct through the papilla, in 2 recurrent intistinal gas in the bile duct. These roentogenologic findings reveal significant inflammatory invasion of the papilla of Vater, and the recurrence of the intestinal contents into the bile duct suggests a dysfunction of the Oddi's sphincter. (3) Severe clinical symptoms and signs are expressed in 7 cases of paravaterian diverticula. In 1 case of these shoes cholelithiasis, and in 4 cases present an enlargement of the major papilla. (4) Malignant tumor of the duodenum and the neighbouring organs are 10 cases. These are 2 cases of pancreatic cancer, 5 of carcinoma of the papilla of Vater, and a case of duodenal carcinoma, lymphsarcomatosis and gastric cancer. Roentogenologic features of these malignant tumors of the papilla of Vater are as follows; As the direct symptom, (1) constant filling defect on the 2nd portion of the duodenum with irregular contour, (2) irregular, winded and interruption of duodenal mucosal folds of the vicinity of the filling defect, (3) rigidity of contour of the viscus, and as indirect symptoms, (4) longitudinal filling difect of the duodenal bulb caused by enlarged bile duct and occasionally (5) inverted 3-sign of the duodenal loop.
- 千葉大学の論文
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