Kamisawa Terumi, Egawa Naoto, Nakajima Hitoshi, Sakaki Nobuhiro, Tsuruta Kouji, Okamoto Atsutake
Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, 113-8677 Tokyo, Japan.
Hepatogastroenterology. 2003 Nov-Dec;50(54):2196-8.
BACKGROUND/AIMS: The accessory pancreatic duct is the smaller and less constant pancreatic duct in comparison with the main pancreatic duct. We investigated the patency of the accessory pancreatic duct and its role in pancreatic pathophysiology.
Dye-injection endoscopic retrograde pancreatography was performed in 411 patients. In patients in whom the main pancreatic duct could be selectively cannulated, contrast medium with indigo carmine was injected through the catheter. Excretion of the dye from the minor duodenal papilla was observed endoscopically.
Patency of the accessory pancreatic duct was 43% of the 291 control cases. In the 46 patients with acute pancreatitis, 8 (17%) had a patent accessory pancreatic duct. The difference in patency between this group and the normal group was significant (p < 0.01). Especially, patency of the accessory pancreatic duct was only 8% of the 13 patients with acute biliary pancreatitis. In the patients with pancreaticobiliary maljunction, biliary carcinoma occurred in 72% of patients with a nonpatent accessory pancreatic duct, but in contrast, it occurred only in 30% of those with a patent accessory pancreatic duct. This difference was significant (p < 0.05). Lower amylase level in the bile of patients with pancreaticobiliary maljunction with a patent accessory pancreatic duct was frequently observed than those with a nonpatent accessory pancreatic duct.
A patent accessory pancreatic duct may prevent acute pancreatitis by lowering the pressure in the main pancreatic duct. In cases of pancreaticobiliary maljunction with a patent accessory pancreatic duct, the incidence of carcinogenesis of the bile duct might be lower, as the reflux of the pancreatic juice to the bile duct might be reduced by the flow of the pancreatic juice into the duodenum through the accessory pancreatic duct.
背景/目的：与主胰管相比，副胰管较小且存在情况不恒定。我们研究了副胰管的通畅情况及其在胰腺病理生理学中的作用。
对411例患者进行了染料注射内镜逆行胰胆管造影术。在能够选择性插管至主胰管的患者中，通过导管注入含靛胭脂的造影剂。在内镜下观察染料从小十二指肠乳头的排泄情况。
291例对照病例中副胰管通畅率为43%。在46例急性胰腺炎患者中，8例（17%）副胰管通畅。该组与正常组的通畅率差异有统计学意义（p<0.01）。特别是，13例急性胆源性胰腺炎患者中副胰管通畅率仅为8%。在胰胆管合流异常患者中，副胰管不通畅的患者胆管癌发生率为72%，而副胰管通畅的患者仅为30%。这种差异有统计学意义（p<0.05）。与副胰管不通畅的胰胆管合流异常患者相比，副胰管通畅的患者胆汁中淀粉酶水平较低的情况更为常见。
副胰管通畅可能通过降低主胰管压力来预防急性胰腺炎。在副胰管通畅的胰胆管合流异常病例中，胆管癌变的发生率可能较低，因为胰液可通过副胰管流入十二指肠，从而减少胰液向胆管的反流。
