Benage D, McHenry R, Hawes R H, O'Connor K W, Lehman G A
Department of Medicine, Indiana University School of Medicine, Indianapolis.
Gastrointest Endosc. 1990 Nov-Dec;36(6):553-7. doi: 10.1016/s0016-5107(90)71162-5.
Until recently, pancreas divisum represented a major technical barrier to a complete evaluation of pancreatic ductal anatomy. Technical refinements have now made it possible to achieve minor papilla cannulation and dorsal ductography in more than 90% of attempts. In 120 consecutive dorsal ductograms, structural pathology was demonstrated in 36 subjects (30%): chronic pancreatitis in 23, pancreatic stones in 10, pseudocyst(s) in 4, ductal "cut-off" in 7, pancreatic cancer in 3, and partial agenesis in 1 (some patients had more than one finding). For patients in whom alcohol abuse was excluded, ductal pathology was present in 25%. Abnormal ventral ductograms were present in only 8% of cases, demonstrating that dorsal ductography has an appreciable additional diagnostic yield. When the clinical situation indicates the need for pancreatography, minor papilla cannulation should be performed if major papilla cannulation fails or reveals only the ventral pancreatogram of pancreas divisum.
直到最近，胰腺分裂仍是全面评估胰管解剖结构的一个主要技术障碍。技术的改进现已使在超过90%的尝试中实现小乳头插管和背侧胰管造影成为可能。在连续120例背侧胰管造影中，36例（30%）显示有结构病变：23例为慢性胰腺炎，10例为胰石，4例为假性囊肿，7例为导管“截断”，3例为胰腺癌，1例为部分发育不全（一些患者有不止一项发现）。对于排除了酒精滥用的患者，25%存在导管病变。仅8%的病例腹侧胰管造影异常，这表明背侧胰管造影有相当可观的额外诊断价值。当临床情况表明需要进行胰腺造影时，如果主乳头插管失败或仅显示胰腺分裂的腹侧胰管造影，则应进行小乳头插管。
