Farias L R, Frey C F, French S, Gunther R
Department of Surgery, University of California, Sacramento.
Int J Pancreatol. 1986 May;1(1):51-9. doi: 10.1007/BF02795239.
The effect of relieving pancreatic duct obstruction after the onset of hemorrhagic pancreatitis was investigated. Hemorrhagic pancreatitis was produced in 20 pigs by a bile salt-trypsin retrograde injection technique. In half the pigs the pancreatic duct was permanently ligated, and in the other half the ductal obstruction was relieved 2 h after the onset of hemorrhagic pancreatitis. The overall mortality rate was the same in both groups by 24 h. No difference was found between the groups in the gross and microscopic appearance of histological samples taken from the pancreas immediately after death. The biochemical parameters measured to assess the severity of pancreatitis such as calcium, BUN, creatinine, glucose, proteins, and hematocrit did not show any difference between the two groups. The serum amylase level, a measure of ductal obstruction, was less at 24 h and even lower at 48 h in the release group as compared to the non-release group. This difference suggests that the ductal obstruction was relieved, as the amylase levels declined at 24 and 48 h. Hemodynamic variables, including cardiac output, pulmonary artery pressure, pulmonary wedge pressure, central venous pressure, and aortic pressure were followed. No significant difference was found in any of these parameters between the two groups. The absence of any significant differences in hemodynamic status, histopathological findings, and biochemical analysis in our pigs, if translatable to man, does not lend support to early operative intervention in gallstone pancreatitis in the hope that those patients who already have hemorrhagic pancreatitis will benefit from early pancreatic ductal decompression.
研究了出血性胰腺炎发病后解除胰管梗阻的效果。采用胆盐-胰蛋白酶逆行注射技术在20头猪身上诱发出血性胰腺炎。其中一半猪的胰管被永久性结扎，另一半猪在出血性胰腺炎发病后2小时解除导管梗阻。到24小时时，两组的总体死亡率相同。死后立即从胰腺采集的组织学样本在大体和显微镜外观上，两组之间未发现差异。为评估胰腺炎严重程度而测量的生化参数，如钙、尿素氮、肌酐、葡萄糖、蛋白质和血细胞比容，两组之间没有任何差异。作为导管梗阻指标的血清淀粉酶水平，与未解除梗阻组相比，解除梗阻组在24小时时较低，在48小时时更低。这种差异表明，随着淀粉酶水平在24小时和48小时下降，导管梗阻得到了解除。对包括心输出量、肺动脉压、肺楔压、中心静脉压和主动脉压在内的血流动力学变量进行了跟踪。两组在这些参数中的任何一项上均未发现显著差异。在我们的猪身上，血流动力学状态、组织病理学发现和生化分析均未发现任何显著差异，如果这能应用于人类，那么对于胆石性胰腺炎，早期手术干预以期那些已经发生出血性胰腺炎的患者能从早期胰管减压中获益，这种做法是没有依据的。
