Unno Hiroshi, Saegusa Hisanobu, Fukushima Mana, Hamano Hideaki
The Second Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
Gastrointest Endosc. 2002 Dec;56(6):880-4. doi: 10.1067/mge.2002.129605.
There are no descriptions of the appearance of the main duodenal papilla in sclerosing pancreatitis. The intent of the present study was to clarify the characteristics of the main duodenal papilla in patients with sclerosing pancreatitis.
Macroscopic findings at ERCP with reference to the main duodenal papilla of 17 patients with sclerosing pancreatitis were compared with those of 24 patients with normal ERCP findings, 11 with chronic pancreatitis, 13 with primary sclerosing cholangitis, 21 with pancreatic cancer, and 18 with bile duct cancer. Endoscopic photographs of the papilla were reviewed retrospectively by 3 observers blinded to the underlying pancreaticobiliary pathology. Degree of swelling was scored in all patients. Biopsy specimens from swollen papillae were assessed histopathologically in 3 patients with sclerosing pancreatitis.
Severe swelling of the main duodenal papilla was observed in 7 (41%) of 17 patients with sclerosing pancreatitis. The total score for the degree of swelling in patients with sclerosing pancreatitis was significantly higher than that for patients with a normal ERCP, chronic pancreatitis, primary sclerosing cholangitis, pancreatic cancer, and bile duct cancer (p < 0.01). T-lymphocyte infiltration of the papilla was evident in the biopsies from 3 patients with sclerosing pancreatitis.
A swollen main duodenal papilla was a characteristic finding in patients with sclerosing pancreatitis. T-lymphocyte infiltration is present in the swollen main duodenal papilla. These features may be useful in the diagnosis of sclerosing pancreatitis.
目前尚无关于硬化性胰腺炎主十二指肠乳头外观的描述。本研究旨在明确硬化性胰腺炎患者主十二指肠乳头的特征。
将17例硬化性胰腺炎患者经内镜逆行胰胆管造影（ERCP）时主十二指肠乳头的宏观表现，与24例ERCP结果正常的患者、11例慢性胰腺炎患者、13例原发性硬化性胆管炎患者、21例胰腺癌患者及18例胆管癌患者的表现进行比较。由3名对潜在胰胆管病变不知情的观察者对乳头的内镜照片进行回顾性评估。对所有患者的肿胀程度进行评分。对3例硬化性胰腺炎患者肿胀乳头的活检标本进行组织病理学评估。
17例硬化性胰腺炎患者中有7例（41%）观察到主十二指肠乳头严重肿胀。硬化性胰腺炎患者的肿胀程度总分显著高于ERCP结果正常的患者、慢性胰腺炎患者、原发性硬化性胆管炎患者、胰腺癌患者及胆管癌患者（p < 0.01）。3例硬化性胰腺炎患者的活检显示乳头有明显的T淋巴细胞浸润。
主十二指肠乳头肿胀是硬化性胰腺炎患者的一个特征性表现。肿胀的主十二指肠乳头存在T淋巴细胞浸润。这些特征可能有助于硬化性胰腺炎的诊断。
