膵癌の早期診断

We had 31 cases of the carcinoma of the pancreas including the carcinomas of the Papilla Vateri and the intrapancreatic bile duct, in which laparotomy was rmade at the National Cancer Center Hospital, Radical excision was performed in only 5 among 9 cases of pancreatoduodenectomy or total pancreatectomy, and 3 cases of distal pancreatectomy were all palliative. The problem of the early diagnosis was discussed about these cases.<br>(1) Vague upper abdominal discomfort or pain was the chief complaint in 21 of 31 cases (68%), and jaundice was seen in 11 of 31 cases (35%). As the initial complaint, upper abdominal discomfort or pain was seen in 20 of 31 cases (65%) and jaundice was seen in three of 31 cases, Among 23 cases of the carcinoma of the head of the pancreas, jaundice was associated in 12 cases, of which the excision was done in 8 cases including four cases of radical excision, In other cases without jaundice, exploratory laparotomy or anastomosis was performed in 10 cases, except one case of radical excision of the early cancer. Therefore, early diagnosis of carcinoma of the head of the pancreas without jaundice is quite. important. In 16 cases with palpable tumor-mass, palliative excision was able to carry out in 4 cases, but among 6 cases which gall-bladder was palpated, curative excision was done in 2 cases.<br>(2) Examination of upper gastro-intestinal tract by barium meal is important procedure to differentiate other diseases and the pancreatic tumor. Abnormal findings, such as pressure effect to the stomach (Fig. 2) and duodenum, were seen in 27 out of 31 cases (87%). The pancreatic tumor was demonstrated on the X-ray film by means of the transverse axial stratigraphy of the upper abdomen (Fig. 4). The tumor shadow was well correspond with the anatomical location at the time of operation. Selective angiography of the pancreas was also useful tool for difficult cases to diagnose (Fig. 5). But both methods were scanty in case to diagnose early.<br>Although we have previously reported that the exocrine function of the pancreas measured by pancreozymin-secretin test was related to the location and the degree of obstruction of pancreatic duct, and was not always parallel to the size of the pancreatic tumor, radical excision of pancreatic tumor was more frequently performed in cases with slight dysfunction among cases with the carcinoma of the head of the pancreas. It was emphasized that the dysfunction by pancreozymin-secretin test and the positive cytology for duodenal content are useful for the diagnosis of relatively early stage of the carcinoma of the pancreas. The exfoliative cytology for duodenal content obtained by pancreozymin-secretin stimulation was positive in 6 out of 11 cases with the carcinoma of the pancreas, and the radical excision was made in 3 cases among those cases.<br>(3) The findings of the gall-bladder and the bile duct at the operation is also important for differential diagnosis in cases with jaundice, since the enlarged gall-bladder and bile duct without inflammatory change often indicate the carcinomatous obstruction of distal biliary tract. We had a case with adenocarcinoma of biliary tract in the head of the pancreas, about 1×0.8×1.2cm in sized (Fig. 7), and in this case pancreatoduodenectomy was made without biopsy, since the carcinoma of the head of the pancreas was strongly suspected by non-inflammatory enlargement of the gall-bladder and bile duct.