| 特集名 | 膵管内乳頭粘液性腫瘍 (IPMT ; intraductal papillary-mucinous tumor) | |
|---|---|---|
| 題名 | 診断 (2) 診断と鑑別 c. バルーンカテーテルERP-圧迫撮影法，十二指腸内視鏡 | |
| 発刊年月 | 2006年 02月 | |
| 著者 | 池田 靖洋 | 福岡大学医学部第一外科 |
| 著者 | 笠 普一郎 | 福岡大学医学部第一外科 |
| 著者 | 緒方 賢司 | 福岡大学医学部第一外科 |
| 著者 | 眞栄城 兼清 | 福岡大学医学部第一外科 |
| 著者 | 安波 洋一 | 福岡大学医学部第一外科 |
| 著者 | 濱田 義浩 | 福岡大学医学部病理 |
| 著者 | 中山 吉福 | 福岡大学医学部病理 |
| 【 要旨 】 | バルーンERP-CSによる膵管像から分類したIPMTの病型別に，バルーンERP-CS像を呈示し，ERPの診断能につき解説した． 分枝膵管拡張型は，ERPで粘液像や嚢胞との交通が証明され，鑑別診断に有用である．しかし，嚢胞は十分造影されない症例が多い．同拡張優位型 (主膵管径≥5mm) は，バルーンERP-CSで造影される例が多く，本法は病変部の精査や経過観察に役立つ． 主膵管拡張型は，粘液量が多く，乳頭口の開大を伴う例がほとんどである．そのため，病変部の性状診断や拡がり診断には，粘液を吸引除去し，バルーンERP-CSを行う必要がある．粘液と結節状隆起の鑑別，実質浸潤などの診断には，EUSが不可欠である．MCTとserous cystadenomaの膵管圧排像には，異なる特徴がある． |
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| Theme | IPMT ; Intraductal Papillary-Mucinous Tumor | |
|---|---|---|
| Title | Diagnosis of Intraductal Papillary Mucinous Tumor of the Pancreas by Balloon-Catheter ERP-Compression Study (Balloon ERP-CS) | |
| Author | Seiyo Ikeda | First Department of Surgery, Fukuoka University School of Medicine |
| Author | Shinichiro Ryu | First Department of Surgery, Fukuoka University School of Medicine |
| Author | Kenji Ogata | First Department of Surgery, Fukuoka University School of Medicine |
| Author | Kensei Maeshiro | First Department of Surgery, Fukuoka University School of Medicine |
| Author | Yohichi Yasunami | First Department of Surgery, Fukuoka University School of Medicine |
| Author | Yoshihiro Hamada | Department of Pathology, Fukuoka University School of Medicine |
| Author | Yoshifuku Nakayama | Department of Pathology, Fukuoka University School of Medicine |
| [ Summary ] | IPMT arises from the pancreatic ductal epithelium ; therefore, it is important to precisely show the wall of the duct. However, conventional ERP is frequently insufficient because of mucus retention and enlargement of the papilla Vateri orifice. Balloon ERP-CS can overcome these limitations and can allow excellent visualization of the pancreatic duct. In cases with a copious amount of mucus retention, mucus aspiration with a large bore catheter before performing balloon ERP-CS can eradicate the effect of mucus retention. Ductal dilatation of IPMT can be classified into three types based on balloon ERP-CS findings. In cases of Branch Duct A type without dilatation of the main duct, even balloon ERP-CS is somewhat limited in visualizing the cystic lesions. While in most cases of Branch Duct B type with the main duct of more than a 5 mm dilation, the multilocular cyst is well visualized by the balloon ERP-CS. Thus, the pancreatograms can also be used for follow-up observation of the cystic tumors. In Main Duct type cases with a highly dilated main pancreatic duct, balloon ERP-CS can precisely determine the presence of an elevated lesion inside the duct, which is one of our chief pancreatographic criteria for malignancy. EUS is very useful in differentiating mucus from polypoid tumors and diagnosing the presence of invasion. |
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