DUODENOSCOPY AND RETROGRADE PANCREATOCHOLANGIOGAPHY
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概要
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Fiberoptic duodenoscopy has opened new vistas in diagnostics of obstructive jaundice and pancreatic diseases by its versatile functions such as direct visualization of the papilla of Vater and retrograde contrast visualization of the pancreaticobiliary complex. During the year of 1971 the author performed duodenoscopy with Olympus Duodenofiberscope JF-B in 120 cases among which pancreatocholangiography was successfully done in 52 and direct-vision biopsy in 23. Laparotomy (63 cases), autopsy (4) and other diagnostic means confirmed duodenoscopic diagnoses, which included cardiac carcinoma (4 cases), gastric sarcoma (3), pyloric ulcer (7), prepyloric polyp, (3), duodenal ulcer (16), duodenal polyp (13), duodenal diverticulum (12), cholelithiasis (25), biliary-tract carcinoma (10), pancreatic carcinoma (6), carcinoma of the papilla of Vater (1), chronic pancreatitis (10), hepatoma (1), hepatitis (2), amyloidosis (1), biliary cirrhosis (1) and retroperitoneal sarcoma (2). Correct differential diagnoses were reached in 24 cases with obstructive jaundice. Examples of most convincing cases were cancer of the papilla of Vater preoperatively diagnosed by ducdenocsopic biopsy leading to successful pancreatoduodenectomy and a pancreatic pseudocyst visualized by cluodenoscopic pencreatography and treated by distal pancreatectomy. Duodenoscopic cholangiography was especially useful in demonstrating presence (location and number) or absence of gallstones which was not confirmed either way by IV. cholangiography. By simultaneous pancreatography informations were obtained regarding accompanying papillitis or pancreatitis. Pancreatocholangicgrams were not obtained in 9 cases (such as cancer of the gallbladder infiltrating the duodenum, cancer of the head of the pancreas, chronic cholecystitis with thick adhesion with the pylorus and gallstone wedged in the ampulla of Vater) in which percutareous transhepatic cholangiography proved more effective. Currently duodenoscopic pancreatography is the only practical way of non-operative visualization of the pancreatic duct. Its significant role cannot be overemphasized in the diagnosis and effective treatment of pancreatic disorders which has continued to be a challenging problem. For correct interpretation of pancreatograms findings of operative pencreatography and pathologists' observations of bile anal pancreatic ducts were reviewed in detail. Preoperative duodenoscopy with retrograde pancreatocholangiography can correctly influence surgeon's selection of operative procedures in papillitis, chronic pancreatitis, pancreatic cancer and obstructive jaundice. No serious ill-effects of the examinations were encountered. Postpancreatographic rise in serum amylase was detected, usually in the first few hours, in one-third of cases, but was not considered as a reflection of acute pancreatitis. Its possible mechanism was discussed. Duodenoscopy is a safe and effective technic which permits over-all observation of the upper gastrointestinal tract and a new approach to the binary tract-pancreatic disease.
- 社団法人 日本消化器内視鏡学会の論文
著者
関連論文
- 61. 原発巣および転移腹水中における胃癌細胞形態の比較(一般講演 , 第12回日本臨床細胞学会総会講演要旨)
- DUODENOSCOPY AND RETROGRADE PANCREATOCHOLANGIOGAPHY