Taylor T V, Rimmer S, Holt S, Jeacock J, Lucas S
Manchester Royal Infirmary and Medical School, United Kingdom, England.
Ann Surg. 1991 Dec;214(6):667-70. doi: 10.1097/00000658-199112000-00005.
From a computerized database comprising 28 pertinent items in each of a consecutive series of 664 patients with cholelithiasis, differences were studied between men and women. In 52 patients there was a documented attack of acute pancreatitis (7.8%). Twenty-five of 174 men had pancreatitis, compared with 27 of 490 women (p less than 0.0001). Men developed gallstones later in life than women, but suffered gallstone pancreatitis earlier in life and in the course of their gallstone-related disease. A history of flatulent dyspepsia, chronic cholecystitis, and biliary colic was less common in men than in women with pancreatitis (p less than 0.0001). Men with pancreatitis had fewer stones in their gallbladders than did women (p = 0.0002). The cystic duct and the common bile duct in the pancreatitic patient were more likely to be dilated (p less than 0.0001). In the nonpancreatic group, these ducts were larger in men. Pancreatic duct reflux on operative cholangiography was more common both in patients with pancreatitis 62% cf 14% (p less than 0.0001), and in men (p less than 0.001). Predisposition to pancreatitis relates to duct size rather than stone size per se. Men are more susceptible to gallstone migration at an early stage of their disease. In addition they have a larger diameter duct system and possibly a different anatomic disposition of the sphincter of Oddi, which predisposes them to a higher incidence of pancreatitis than women. The data suggest that it is cystic duct size that is critical in the pathogenesis of gallstone pancreatitis.
从一个计算机化数据库中选取了连续664例胆石症患者，该数据库包含每位患者的28项相关信息，研究了男性和女性之间的差异。52例患者有急性胰腺炎发作记录（7.8%）。174名男性中有25人患胰腺炎，而490名女性中有27人患胰腺炎（p<0.0001）。男性患胆结石的年龄比女性晚，但在生命早期及与胆结石相关疾病过程中更容易患胆石性胰腺炎。有肠胃胀气性消化不良、慢性胆囊炎和胆绞痛病史的男性比患胰腺炎的女性少见（p<0.0001）。患胰腺炎的男性胆囊中的结石比女性少（p = 0.0002）。胰腺炎患者的胆囊管和胆总管更可能扩张（p<0.0001）。在非胰腺炎组中，这些导管在男性中更大。手术胆管造影显示，胰腺炎患者中胰管反流更常见，为62%，而非胰腺炎患者中为14%（p<0.0001），且男性中也更常见（p<0.001）。胰腺炎的易感性与导管大小有关，而非结石本身大小。男性在疾病早期更容易发生胆结石迁移。此外，他们的导管系统直径更大，Oddi括约肌的解剖结构可能也不同，这使得他们比女性更容易患胰腺炎。数据表明，胆囊管大小在胆石性胰腺炎的发病机制中至关重要。
