慢性膵炎の膵管X線像とその診断学的価値 ―屍体膵を用いての研究―

Postmortem pancreas tissue was prepared within 6 hours of death for the comparative study of pancreatographic findings and histological findings to define characteristic pancreatographic findings of chronic pancreatitis and determine their diagnostic value.　Pancreas tissue was obtained from 25 patients with chronic pancreatitis, 12 with pancreatic cancer and 125 with a normal pancreas. Among various pancreatographic findings, irregular dilatation and irregular arrangement of the branches of the pancreatic duct, and also irregular dilatation, rigidity with irregular margin and stenosis with irregular margin of the main pancreatic duct showed the highest sensitivity, specificity, positive predictive value and negative predictive value and thus had the highest diagnostic value. However, the sensitivity was not high enough, indicating that the above pancreatographic findings could be absent at the site of positive histological findings. As for the differential diagnosis between chronic pancreatitis and pancreatic cancer, stenosis accompanied by irregular margin of the main pancreatic duct is more likely to suggest cancer, whereas simple stenosis suggests pancreatitis. The absence of branches suggests cancer, while rigidity accompanied by straightening of branches suggests pancreatitis.