小林 隆

Chronic pancreatitis is progressive and irreversible, leading to digestive and absorptive disorders by destruction of the exocrine pancreas and to diabetes mellitus by destruction of the endocrine pancreas. When complications such as pancreatolithiasis and pseudocyst occur, elevated pancreatic ductal pressure exacerbates pain and induces other complications, worsening the patient's general condition. Combined treatment with extracorporeal shock-wave lithotripsy and endoscopic lithotripsy is a useful, minimally invasive, first-line treatment approach that can preserve pancreatic exocrine function. Pancreatic duct stenosis elevates intraductal pressure and favor both pancreatolithiasis and pseudocyst formation, making effective treatment vitally important. Endoscopic treatment of benign pancreatic duct stenosis stenting frequently decreases pain in chronic pancreatitis. Importantly, stenosis of the main pancreatic duct increases risk of stone recurrence after treatment of pancreatolithiasis. Recently, good results were reported in treating pancreatic duct stricture with a fully covered self-expandable metallic stent, which shows promise for preventing stone recurrence after lithotripsy in patients with pancreatic stricture. Chronic pancreatitis has many complications including pancreatic carcinoma, pancreatic atrophy, and loss of exocrine and endocrine function, as well as frequent recurrence of stones after treatment of pancreatolithiasis. As early treatment of chronic pancreatitis is essential, the new concept of early chronic pancreatitis, including characteristics findings in endoscopic ultrasonograms, is presented.

A 62-year-old man was referred to our hospital after ultrasonographic mass screening detected a pancreatic cyst that proved to be an intraductal papillary mucinous neoplasm. Computed tomography additionally demonstrated air in the main pancreatic duct. Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography delineated a filling defect in the main pancreatic duct in the body of the pancreas. The sphincter of Oddi was open. The main pancreatic duct was dilated by viscous mucin air in the duct was attributed to consequent dysfunction of the sphincter. Laboratory findings included no significant abnormality. The patient has remained asymptomatic during follow-up. Of 25 previously reported cases with air in the duct, only 1 involved an intraductal papillary mucinous neoplasm. © Springer 2013.

今回我々は検診で発見され, 手術を行った胆嚢ポリープについて検討した。対象は当院で超音波検査により胆嚢ポリープと診断された2,152例中, 検診で発見され経過観察中に増大を認め手術した増大後手術群9例および発見時に手術した即時手術群7例であった。増大後手術群は平均径12.9mm, 増大速度が平均2.6mm/年で病理組織所見はコレステロールポリープ7例, 乳頭状過形成1例, 管状腺腫1例であった。即時手術群は平均径13.1mmで, 病理組織所見はコレステロールポリープ5例, 炎症性ポリープ1例, 腺腫内癌1例であった。増大後手術群と比較して即時手術群は発見時の径が有意に大きく, 単発例が有意に多かった。内部エコーは増大後手術群では実質様・等エコーを示すものが多く, 即時手術群では小嚢胞様構造を示すものが多かった。実質様・等エコーを示す胆嚢ポリープが増大した場合には腺腫あるいは腺腫内癌を考慮する必要がある。