Kondo Hiromu, Naitoh Itaru, Okumura Fumihiro, Nakazawa Takahiro, Hayashi Kazuki, Miyabe Katsuyuki, Shimizu Shuya, Nishi Yuji, Yoshida Michihiro, Umemura Shuichiro, Hori Yasuki, Kato Akihisa, Ohara Hirotaka, Joh Takashi
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan.
J Gastroenterol Hepatol. 2016 Jul;31(7):1366-73. doi: 10.1111/jgh.13304.
The clinical features of acute obstructive suppurative pancreatic ductitis (AOSPD) have not been elucidated. We aimed to clarify the clinical features of AOSPD.
We retrospectively reviewed the clinical features of 20 patients with AOSPD at two tertiary referral centers between 1993 and 2012. We compared 17 AOSPD patients with chronic pancreatitis (CP) and 42 patients with acute-on-CP in terms of clinical characteristics, presentation, and laboratory and imaging findings.
The etiology of AOSPD involved CP in 17 (85%) patients, pancreatic ductal adenocarcinoma in 2 (10%), and intraductal papillary mucinous neoplasm in 1 (5%). Endoscopic pancreatic drainage was effective in 19 (95%) patients. Body temperature was significantly higher in AOSPD with CP than acute-on-CP patients (median: 38.2 vs 36.9 °C; P < 0.001). Serum amylase levels at onset were significantly lower (median: 133 vs 364.5 U/L; P = 0.009), and C-reactive protein was significantly higher (median: 9.42 vs 1.06 mg/dL; P < 0.001) in AOSPD with CP patients. Enlargement of the pancreatic parenchyma (18 vs 93%; P < 0.001) and stranding of the surrounding fat (12 vs 93%; P < 0.001) on computed tomography were observed less frequently in patients with AOSPD with CP patients. The diameter of the main pancreatic duct was significantly greater in AOSPD with CP than acute-on-CP patients (median: 7 vs 5 mm; P = 0.006).
The major etiology of AOSPD involved CP, and endoscopic pancreatic drainage was effective. The clinical features differ between AOSPD with CP and acute-on-CP.
急性梗阻性化脓性胰管炎（AOSPD）的临床特征尚未阐明。我们旨在明确AOSPD的临床特征。
我们回顾性分析了1993年至2012年间在两家三级转诊中心的20例AOSPD患者的临床特征。我们比较了17例AOSPD患者与慢性胰腺炎（CP）患者以及42例CP急性发作患者的临床特征、表现、实验室检查及影像学检查结果。
AOSPD的病因中，17例（85%）为CP，2例（10%）为胰腺导管腺癌，1例（5%）为导管内乳头状黏液性肿瘤。19例（95%）患者接受内镜下胰管引流有效。合并CP的AOSPD患者体温显著高于CP急性发作患者（中位数：38.2对36.9°C；P<0.001）。合并CP的AOSPD患者发病时血清淀粉酶水平显著更低（中位数：133对364.5 U/L；P=0.009），C反应蛋白显著更高（中位数：9.42对1.06 mg/dL；P<0.001）。在计算机断层扫描中，合并CP的AOSPD患者胰腺实质增大（18%对93%；P<0.001）及周围脂肪条索状改变（12%对93%；P<0.001）的发生率更低。合并CP的AOSPD患者主胰管直径显著大于CP急性发作患者（中位数：7对5 mm；P=0.006）。
AOSPD的主要病因是CP，内镜下胰管引流有效。合并CP的AOSPD与CP急性发作的临床特征有所不同。
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