Jones B A, Salsberg B B, Mehta M H, Bohnen J M
Ann Surg. 1987 Feb;205(2):123-5. doi: 10.1097/00000658-198702000-00003.
Bile reflux into the pancreatic duct after impaction of a stone in a common pancreaticobiliary channel has been suggested to be the initiating factor in gallstone pancreatitis. Such reflux would require that the impacted stone be smaller than the length of the common channel. The incidence of common channels was studied and gallstone size was compared with common channel length in patients with gallstone pancreatitis and those with cholelithiasis or choledocholithiasis without pancreatitis. Sixty-seven per cent of patients with gallstone pancreatitis had a common channel present on intraoperative cholangiography versus 32% of patients with cholelithiasis or choledocholithiasis without pancreatitis (p less than 0.005). Common channel length was greater than the diameter of the smallest stone in nine of 27 patients with gallstone pancreatitis and in 13 of 109 patients with cholelithiasis or choledocholithiasis without pancreatitis (p less than 0.025). In conclusion, common channels are more frequent in patients with gallstone pancreatitis than in patients with other biliary tract disease. Furthermore, gallstone pancreatitis is associated with stones that are smaller than the common channel, which favors obstruction of both pancreatic and bile ducts while allowing reflux of contents between them.
在胰胆管共同通道结石嵌顿后胆汁反流至胰管被认为是胆石性胰腺炎的起始因素。这种反流要求嵌顿的结石小于共同通道的长度。研究了共同通道的发生率，并比较了胆石性胰腺炎患者以及患有胆石症或胆总管结石但无胰腺炎患者的胆石大小与共同通道长度。术中胆管造影显示，67%的胆石性胰腺炎患者存在共同通道，而患有胆石症或胆总管结石但无胰腺炎的患者中这一比例为32%（p<0.005）。在27例胆石性胰腺炎患者中有9例、109例患有胆石症或胆总管结石但无胰腺炎的患者中有13例，共同通道长度大于最小结石的直径（p<0.025）。总之，胆石性胰腺炎患者中共同通道比其他胆道疾病患者更为常见。此外，胆石性胰腺炎与小于共同通道的结石有关，这有利于胰管和胆管同时梗阻，同时允许两者之间的内容物反流。
