Kiewiet Jordy J S, Moret Marlous, Blok Willem L, Gerhards Michael F, de Wit Laurens T
Departments of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
Case Rep Gastroenterol. 2009 Apr 7;3(1):36-42. doi: 10.1159/000210442.
Two patients presented with dyspnea and signs of chronic pancreatitis. Patient B had pleural effusion on chest X-ray. Patient A developed pleural effusion during the course of disease. On further analysis these pleural effusions showed elevated amylase concentrations. This finding suggested the diagnosis of a pancreaticopleural fistula which was confirmed by magnetic resonance cholangiopancreatography. Because of the distinct localization of the fistulas the patients were treated differently. In patient A an endoprosthesis was successfully placed in the pancreatic duct, and patient B underwent distal pancreatic resection. Considering the rarity of pancreaticopleural fistula, there is no consensus on diverse aspects of treatment, such as length of treatment with octreotide. However, a rationale for the distinction between fistulas suited for treatment with endoprosthesis or surgery seems to provide some grip.
两名患者出现呼吸困难及慢性胰腺炎体征。患者B胸部X线检查显示有胸腔积液。患者A在病程中出现胸腔积液。进一步分析发现，这些胸腔积液的淀粉酶浓度升高。这一发现提示胰胸膜瘘的诊断，磁共振胰胆管造影证实了这一诊断。由于瘘管的位置不同，两名患者接受了不同的治疗。患者A成功地在胰管内放置了内支架，患者B接受了胰腺远端切除术。鉴于胰胸膜瘘的罕见性，对于治疗的各个方面，如奥曲肽治疗的时长，尚无共识。然而，区分适合内支架治疗或手术治疗的瘘管的理论依据似乎提供了一些可循之处。
