Nakashio K
Second Department of Internal Medicine, Faculty of Medicine, Kagoshima University, Japan.
Igaku Kenkyu. 1992 Apr;62(2):39-55.
Usefulness of endoscopic ultrasonography (EUS) for the diagnosis of chronic pancreatitis, particularly for mild chronic pancreatitis and so-called clinically suspected chronic pancreatitis diagnosed by the criteria documented by the Committee of Japanese Society of Gastroenterology for chronic pancreatitis (CJSG criteria), is described in this paper. 89 patients with chronic pancreatitis including 43 with mild chronic pancreatitis (MIP), 29 with moderate chronic pancreatitis (MOP) and 17 with advanced chronic pancreatitis (ADP) diagnosed by Endoscopic Retrograde Cholangio-Pancreatography (ERCP) were selected for the study and following results were obtained. 1) The number of findings of wall irregularity of the main pancreatic duct and heterogeneity of the pancreatic parenchyma were more clearly shown by EUS although they had been classified as suspicious of chronic pancreatitis diagnosed by conventional US by the CJSG criteria. 2) The pancreatic parenchymal echo pattern by EUS can be divided into 6 patterns, rough-high echo, spotty-high echo, linear-high echo, rough-low echo, diffuse-high echo and diffuse-low echo. 3) Spotty high echo was observed in high rate in the patients even with MIP showing only a slight change of the main pancreatic ducts by ERCP. Therefore, this pattern could be present in early stage of chronic pancreatitis. 4) The pancreatic parenchymal change by aging detected by EUS was often seen as linear-high and/or diffuse-high echo patterns. 5) Differentiation of changes of the pancreatic parenchyma and wall of the main pancreatic duct by chronic pancreatitis from the change by aging was possible by using EUS. 6) By macro- and micro-scopic studies of the pancreatic parenchyma, pancreatic calculus, fatty change and irregular fibrosis were shown by EUS as rough-high echo accompanied by acoustic shadow, spotty-high echo and rough-low echo patterns respectively.
本文描述了内镜超声检查（EUS）在慢性胰腺炎诊断中的应用价值，尤其是对轻度慢性胰腺炎以及根据日本胃肠病学会慢性胰腺炎委员会制定的标准（CJSG标准）诊断的所谓临床疑似慢性胰腺炎。本研究选取了89例经内镜逆行胰胆管造影（ERCP）诊断为慢性胰腺炎的患者，其中包括43例轻度慢性胰腺炎（MIP）、29例中度慢性胰腺炎（MOP）和17例重度慢性胰腺炎（ADP），并得出以下结果。1）尽管根据CJSG标准，主胰管壁不规则和胰腺实质异质性在传统超声诊断中被归类为慢性胰腺炎可疑，但EUS能更清晰地显示这些表现。2）EUS显示的胰腺实质回声模式可分为6种：粗糙高回声、斑点状高回声、线状高回声、粗糙低回声、弥漫性高回声和弥漫性低回声。3）即使是ERCP显示主胰管仅有轻微改变的MIP患者，斑点状高回声的出现率也很高。因此，这种模式可能出现在慢性胰腺炎的早期。4）EUS检测到的胰腺实质随年龄增长的变化常表现为线状高回声和/或弥漫性高回声模式。5）使用EUS可以区分慢性胰腺炎引起的胰腺实质和主胰管壁的变化与年龄增长引起的变化。6）通过对胰腺实质的宏观和微观研究，EUS显示胰腺结石、脂肪变性和不规则纤维化分别表现为伴有声影的粗糙高回声、斑点状高回声和粗糙低回声模式。
