Ponsky J L, Duppler D W
Department of Surgery, Mt. Sinai Medical Center, Cleveland, OH 44106-4198.
Am Surg. 1987 Oct;53(10):613-6.
Chronic pancreatitis may be associated with pancreatic duct dilatation and ductal stones. Such stones are undoubtedly the result of chronic pancreatitis and stasis within the ductal system and may themselves serve to exacerbate ductal obstruction and recurrent episodes of pancreatitis. Endoscopic sphincterotomy has been used to relieve common duct obstruction secondary to biliary stones. This report suggests that sphincterotomy may also be used to approach selected patients who have pancreatic duct stones and recurrent pancreatitis. The technique involves a preliminary ERCP followed by standard endoscopic sphincterotomy with the papillatome positioned in the bile duct. A balloon catheter is then directed into the pancreatic duct orifice to extract ductal calculi. Although the main duct may be cleared, side branches are more difficult, and perhaps unnecessary, to clear. This method has provided relief of pain in a limited series of patients and may mark the beginning of a more aggressive approach to pancreatic endoscopy.
慢性胰腺炎可能与胰管扩张和导管结石有关。这些结石无疑是慢性胰腺炎和导管系统内淤滞的结果，它们本身可能会加剧导管阻塞和胰腺炎的反复发作。内镜括约肌切开术已被用于缓解继发于胆结石的胆总管梗阻。本报告表明，括约肌切开术也可用于治疗某些患有胰管结石和复发性胰腺炎的患者。该技术包括先行内镜逆行胰胆管造影（ERCP），然后使用乳头切开刀置于胆管内行标准内镜括约肌切开术。接着将球囊导管插入胰管开口以取出导管结石。尽管主胰管可能得以清理，但清理侧支胰管则更为困难，或许也没有必要。该方法已使少数患者的疼痛得到缓解，可能标志着对胰腺内镜检查采取更积极方法的开端。
