Ali Tauseef, Srinivasan Nandakumar, Le Vu, Chimpiri A Rao, Tierney William M
Departments of Internal Medicine-Section of Digestive Disease, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73013, USA.
Pancreas. 2009 Jan;38(1):e26-31. doi: 10.1097/MPA.0b013e3181870ad5.
Pancreaticopleural fistula (PPF) is an unusual complication of chronic pancreatitis. Its diagnosis is obscured by predominance of pulmonary symptoms. A review of clinical presentation, etiology, diagnostic, and treatment modalities is presented in context of 2 cases from our institution.
Case reports and case series of PPFs in the English literature from 1960 to 2007 were identified in the PubMed, OVID, and EMBASE search engines.
Fifty-two cases of PPF were identified. Common presenting complaint was dyspnea (65%) followed by abdominal pain (29%), cough (27%) and chest pain (23%). Computed tomography scanning diagnosed PPF in 8 (47%) of 17 patients, endoscopic retrograde cholangiopancreatography diagnosed PPF in 25 (78%) of 32 patients, and magnetic resonance cholangiopancreatography diagnosed PPF in 8 (80%) of 10 patients. Twenty-one patients (65%) improved with conservative management alone. Interventional therapy (5 endoscopic and 6 surgical interventions) was eventually needed in 35% of the patients after failing conservative management.
Pancreaticopleural fistula is a rare finding and requires a high index of suspicion for patients presenting with chest symptoms or pleural effusion and with history of pancreatitis or alcoholism. Magnetic resonance cholangiopancreatography is the better initial choice for being a noninvasive procedure and for better demonstration of complete main pancreatic duct obstruction. Restoring anatomic continuity is important if conservative approach fails.
胰胸膜瘘（PPF）是慢性胰腺炎的一种罕见并发症。其诊断因肺部症状占主导而变得模糊。结合我院的2例病例，对其临床表现、病因、诊断及治疗方式进行综述。
通过在PubMed、OVID和EMBASE搜索引擎中检索，确定了1960年至2007年英文文献中关于PPF的病例报告和病例系列。
共确定52例PPF病例。常见的首发症状为呼吸困难（65%），其次是腹痛（29%）、咳嗽（27%）和胸痛（23%）。计算机断层扫描在17例患者中的8例（47%）诊断出PPF，内镜逆行胰胆管造影在32例患者中的25例（78%）诊断出PPF，磁共振胰胆管造影在10例患者中的8例（80%）诊断出PPF。21例患者（65%）仅通过保守治疗得到改善。35%的患者在保守治疗失败后最终需要介入治疗（5例内镜介入和6例手术介入）。
胰胸膜瘘是一种罕见的疾病，对于有胸部症状或胸腔积液且有胰腺炎或酗酒史的患者需要高度怀疑。磁共振胰胆管造影作为一种非侵入性检查方法，且能更好地显示主胰管完全梗阻，是更好的初始选择。如果保守治疗失败，恢复解剖连续性很重要。
