遠藤 正章, 佐々木 睦男, 鈴木 英登士, 戸張 雅晴, 吉田 尚弘, 工藤 邦夫, 小野 慶一

Masaaki ENDOH, Mutsuo SASAKI, Hidetoshi SUZUKI, Masaharu TOBARI, Naohiro YOSHIDA, Kunio KUDOH, Keiichi ONO

弘前大学医学部第二外科

The 2nd Department of Surgery, Hirosaki University School of Medicine

キーワード : Ultrasonography, Distal common bile duct, Narrow distal segment, Duodenal papilla

　We applied the water filling technique of the stomach and the duodenum in order to obtain the ultrasonogram of the distal common bile duct and the duodenal papilla.
　The procedures were as follows: (1) Scopolamine butylbromide (20 mg) was administered intramuscularly in fasting state. (2) The stomach and the duodenum were filling with about 400 ml of water in right decubitus position at 3 to 5 minutes after the injection. (3) Linear electronic scanning was performed mainly with right decubitus or sitting position.
　With this method, the distal common bile duct (narrow distal segment—NDS) was visualized as a thin ductal structure and the duodenal papilla as a small protuberance into the duodenum. The wall of the NDS was mainly composed of two hyperechoic lines and one hypoechoic layer.
　Ultrasonogram of the NDS and the duodenal papilla were clearly shown by this method in 19 out of 24 cases (16 with lesions of the pancreatic portion of the common bile duct, the NDS, the duodenal papilla or the head of the pancreas, and 8 without these lesions) and were shown only in 6 cases among these cases by the conventional method.
　These results showed that ultrasonic examination by this method was useful for diagnosis of lesions in the lower part of the common bile duct and the duodenal papilla.