十二指腸内視鏡による膵液・胆汁細胞診に関する研究

抄録

Cytological examinations for pancreatic fluid and bile by cannulation of vater's papilla using duodenofiberscope were performed for 35 cases of cancer and 36 of benign disease in the field of biliary tract and pancreas. The results of this study are as follows:
1. Author compared the results of cytological examination by the flowing, aspiration with la vage method technics. Volume of bile or pancrea tic fluid collected by these technics was not so much in cases of cancer of common bile duct and pancreas and so the investigation for cytol ogy was sometimes difficult. But the result of cytology by lavage method was more favorable compared with other technics.
2. Numbers of exfoliated cells by lavage method were much more than by the flowing or aspiration technique. Lavage method was more effective for the cytological diagnosis of cancer in these fields.
3. 26 cases out of 35 of cancer of pancreas, biliary tract and duodenum were positive cytolo gically by these 3 methods. Positive rate was 74.3%. Only one case (2.8%) was false positive in cytological examinations.
4. 7 cases out of 12 of cancer of the pancreas (58.3%), and 5 out of 9 (55.6%) of cancer of biliary tract were positive in cytology by these technics with combination. But by lavage method only 7 cases out of 10 of cancer of the pancreas (70.0%) and 5 of 8 of cancer of the common bile duct (62.5%) were positive. Also by combination of direct smear method of biopsy specimens from the duodenal mucosa in cases of cancer of panc reas and biliary tract in which cancer cells infil tration were reached in the mucosa of the duode num, 12 cases out of 16 in cancer of the pancreas (75.0%) and 8 of 13 in cancer of biliary tract (61.5%) were positive cytologically.
5. The cytological result was most favorable in cases in head of cancer of the pancreas.This result seems to be depend on the localisation of cancer and the grade of cancer cells infiltration of cancer and the grade of cancer cells infiltra tion to the main duct of the pancreas.
6. All cases of 6 cancer in the duodenum were positive in cytological examinations and all were performed the pancreaticoduodenectomy. However Pancreatico-duodenectomy was performed only 3 cases out of 16 in cancer of the pancreas (18.8%), and 2 of 13 in cancer of biliary tract (15.4%).
7. By combination of endoscopical pancreato graphy and cholangiography and cytology, 13 cases out of 16 in cancer of pancreas (81.3%) and 10 out of 13 of biliary tract (76.9%) were diag nosed correctly before surgery. Cytological exa mination is very effective to make correct diag nosis for cases of negative or suspicious findings by endoscopic pancreato-and cholangiography.
8. Author studied the characteristics of cancer cells from these fields collected by endoscopical technics described above. Cancer cells of pancreas show features of small (under 20μ in diameter), and round nuclei, coarsely aggregated nuclear chromation, little thickning of nuclear border, usually one nucleolus and naked cells are not so many. On the contrary, nuclei of cancer cells of the duodenum are large (over 20μ in diameter). Shape of nuclei are round to long oval. Aggregation of nuclear chromation is remarkable and N/C ratio is increased. Cancer cells of common bile duct showed features between both cancer cells.