Ammann R W, Buehler H, Bruehlmann W, Kehl O, Muench R, Stamm B
Pancreas. 1986;1(3):195-203.
Over the last 10 years, a series of 144 consecutive patients with alcoholic recurrent pancreatitis have been studied prospectively at regular intervals with particular regard to exocrine function, calcifications, pancreatographic ductal changes, and histopathology of the pancreas. Based upon the long-term course, the patients were classified into two groups; group A (n = 95), those with chronic pancreatitis (78 of them with calcifications); and group B (n = 49), those with acute (nonprogressive) pancreatitis. The duration of disease from onset was 2-19 years (median, 9.7 and 8.3 years, respectively, in group A and B). The two groups were comparable at onset of the disease in age, sex, number of episodes of pancreatitis, and number of pseudocysts. In group A, all 95 cases fulfilled the strict diagnostic criteria of chronic pancreatitis within the period of observation (e.g., progressive exocrine insufficiency and/or typical morphological changes, particularly calcifications). In group B, the exocrine function remained normal over the entire period of observation. No histologic evidence of chronic pancreatitis was detected in five of seven large pancreatic specimens. Marked to moderate ductal changes were found in 10 of 16 patients in group B (despite normal exocrine function). Our data suggest that about one third of patients of the present series with alcoholic (recurrent) pancreatitis did not progress toward chronic (progressive) pancreatitis, although some demonstrated morphological alterations (except calcifications) in association with normally preserved exocrine function (residual scars?). The pathogenetic factor(s) responsible for progression (or nonprogression) of alcoholic (recurrent) pancreatitis to chronic pancreatitis remain(s) to be elucidated.
在过去10年中，我们对144例连续性酒精性复发性胰腺炎患者进行了前瞻性研究，定期对其外分泌功能、钙化、胰管造影的导管变化以及胰腺组织病理学进行特别观察。根据长期病程，将患者分为两组：A组（n = 95），即慢性胰腺炎患者（其中78例有钙化）；B组（n = 49），即急性（非进行性）胰腺炎患者。从发病起的病程为2至19年（A组和B组的中位数分别为9.7年和8.3年）。两组在疾病发作时的年龄、性别、胰腺炎发作次数和假性囊肿数量方面具有可比性。在A组中，所有95例患者在观察期内均符合慢性胰腺炎的严格诊断标准（例如，进行性外分泌功能不全和/或典型的形态学改变，特别是钙化）。在B组中，外分泌功能在整个观察期内保持正常。在7个大的胰腺标本中，有5个未检测到慢性胰腺炎的组织学证据。B组16例患者中有10例发现有明显至中度的导管变化（尽管外分泌功能正常）。我们的数据表明，本系列中约三分之一的酒精性（复发性）胰腺炎患者未发展为慢性（进行性）胰腺炎，尽管有些患者表现出与外分泌功能正常保存相关的形态学改变（除钙化外）（残留瘢痕？）。酒精性（复发性）胰腺炎发展（或未发展）为慢性胰腺炎的致病因素仍有待阐明。
