Creaghe S B, Roseman D M, Saik R P
Am Surg. 1981 Jun;47(6):243-6.
A syndrome of distal common bile duct obstruction secondary to the fibrotic effects of chronic pancreatitis has been recognized for some time. A group of ten characteristic patients, seven of whom have undergone surgery, is discussed. The diagnostic techniques and surgical procedures are presented, and the results are analyzed. Three patients with the syndrome were not operated upon and one improved spontaneously. The typical patient was a male alcoholic, average age 48 years, with a history of chronic, relapsing pancreatitis and abdominal pain. The most consistently abnormal laboratory value is a markedly elevated alkaline phosphates level. Endoscopic retrograde pancreaticocholangiography and transhepatic cholangiography are the most useful diagnostic procedures. Fifteen per cent of the most useful diagnostic procedures. Fifteen per cent of the patients operated upon required emergent surgery for acute cholangitis and sepsis. Another 29 per cent required prompt intervention for progressive hepatic failure secondary to biliary cirrhosis. The authors advocate an aggressive approach to establish biliary drainage in the presence of acute cholangitis or biliary cirrhosis. If a dilated pancreatic duct can be demonstrated and abdominal pain is the principal problem a direct procedure on the pancreas is needed.
慢性胰腺炎的纤维化作用继发远端胆总管梗阻综合征已被认识一段时间了。本文讨论了一组10例具有特征性的患者，其中7例已接受手术。介绍了诊断技术和手术方法，并对结果进行了分析。3例该综合征患者未接受手术治疗，1例自行好转。典型患者为男性酗酒者，平均年龄48岁，有慢性复发性胰腺炎和腹痛病史。最持续异常的实验室值是碱性磷酸酶水平明显升高。内镜逆行胰胆管造影和经皮肝穿刺胆管造影是最有用的诊断方法。15%接受手术的患者因急性胆管炎和脓毒症需要急诊手术。另外29%的患者因胆汁性肝硬化继发进行性肝衰竭需要及时干预。作者主张在存在急性胆管炎或胆汁性肝硬化时采取积极措施建立胆道引流。如果能证实胰管扩张且腹痛是主要问题，则需要对胰腺进行直接手术。
