Kreel L, Sandin B
Gut. 1973 Dec;14(12):962-70. doi: 10.1136/gut.14.12.962.
Retrograde pancreatography has been carried out at necropsy in 120 cases and the results have been analysed in statistical detail. With increasing age, changes in pancreatic anatomy occur which must not be taken to indicate pathology. These changes are: (1) low or ptotic position of the pancreas so that the papilla of Vater is below the level of L3; (2) calcification of the splenic and superior mesenteric arteries which produce calcific densities around the pancreas; (3) increasing width of main pancreatic duct along its whole length at about 8% per decade; in the elderly, widths of 1 cm can occur in the main duct in the head of the pancreas without evidence of obstruction; (4) formation of ductular ectasia which affects mainly the interlobular ductules but also intralobular ductules; (5) some ectatic ducts reach the dimensions of cysts, ie, 1-2 cm in diameter. OTHER MORPHOLOGICAL CHANGES WHICH HAVE BEEN DEMONSTRATED AND WHICH MAY PRODUCE DIFFICULTIES IN RADIOLOGICAL INTERPRETATION ARE: (a) narrowed ducts not due to stricture; (b) space-occupying lesions due to superior mesenteric artery, splenic artery, aorta, vertebral osteophytes, sympathetic ganglion, and lymph nodes; (c) metastases in the pancreas-these must be distinguished from primary pancreatic carcinoma. The implications of these findings for endoscopy and isotope pancreatic scanning will be mentioned.
已对120例尸体进行逆行胰管造影，并对结果进行了详细的统计学分析。随着年龄的增长，胰腺解剖结构会发生变化，但这些变化不一定意味着存在病理情况。这些变化包括：（1）胰腺位置低或下垂，致使Vater壶腹低于L3水平；（2）脾动脉和肠系膜上动脉钙化，在胰腺周围产生钙化密度影；（3）主胰管全长宽度每十年增加约8%；在老年人中，胰头主胰管宽度可达1cm，且无梗阻迹象；（4）形成导管扩张，主要影响小叶间导管，也影响小叶内导管；（5）一些扩张的导管达到囊肿大小，即直径1 - 2cm。其他已证实且可能在放射学解读中造成困难的形态学变化包括：（a）非狭窄性的导管狭窄；（b）由肠系膜上动脉、脾动脉、主动脉、椎体骨赘、交感神经节和淋巴结引起的占位性病变；（c）胰腺转移瘤——必须将其与原发性胰腺癌区分开来。将提及这些发现对内镜检查和同位素胰腺扫描的意义。
