臨牀消化器内科 Vol.34 No.12(2-8)


特集名 遭遇の機会が増えたIPMN/膵囊胞―現状と課題
題名 IPMN/膵囊胞の診療 (8) IPMNを含む膵疾患診療における病診連携
発刊年月 2019年 11月
著者 花田 敬士 JA尾道総合病院消化器内科
著者 清水 晃典 JA尾道総合病院消化器内科
著者 横出 正隆 JA尾道総合病院消化器内科
著者 池田 守登 JA尾道総合病院消化器内科
著者 矢野 成樹 JA尾道総合病院消化器内科
著者 栗原 啓介 JA尾道総合病院消化器内科
【 要旨 】 現在日常診療の現場では,人間ドックや健診,地方自治体が行うがん検診などで腹部超音波(US)が広く施行されており,膵管内乳頭粘液性腫瘍(IPMN)を含む膵囊胞性病変に遭遇する機会が増加している.一方,現在の「膵癌診療ガイドライン」では,IPMNは膵癌の危険因子の一つに位置づけられており,IPMNに併存する通常型膵癌に注意する必要がある.近年,膵癌の早期診断を目的に,国内から病診連携を基軸とし,IPMNを含む危険因子を有する患者にUSなどの画像を積極的に介入したプロジェクトが開始されており,早期診断例の増加,5年生存率の改善などが報告されている.今後,国内でのさらなる展開が期待される.
Theme IPMN/Pancreatic Cyst as an Increasing Common Disease -- Current Status and Issues
Title The Relationship between Hospitals and Clinics in the Treatment of Pancreatic Diseases Including IPMN
Author Keiji Hanada Department of Gastroenterology, Onomichi Hospital
Author Akinori Shimizu Department of Gastroenterology, Onomichi Hospital
Author Masakata Yokode Department of Gastroenterology, Onomichi Hospital
Author Morito Ikeda Department of Gastroenterology, Onomichi Hospital
Author Shigeki Yano Department of Gastroenterology, Onomichi Hospital
Author Keisuke Kurihara Department of Gastroenterology, Onomichi Hospital
[ Summary ] Some recent studies have demonstrated that a slight dilatation of the main pancreatic duct and small cystic lesions including intraductal papillary mucinous neoplasm (IPMN) were detected by ultrasonography (US) initially in most pancreatic cancer (PC) cases diagnosed at an early stage. Detecting these abnormal findings in cases with high risk factors outlined in clinical guidelines of PC regarding effective screening systems including image diagnosis, as well as some biological markers should contribute to early diagnosis of PC. Especially, careful attention is needed to diagnose PC concomitant with IPMN at an early stage. Recently, cooperative activities of regional specialist doctors in medical centers and general practitioners such as “Onomichi Project”for early diagnosis of PC have been developed in Japan. In the future, these activities may play an important role in the early diagnosis of PC.
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