Rünzi M, Saluja A, Kaiser A, Gerdes D, Sengupta A, Steer M L
Department of Surgery, Beth Israel Hospital, Harvard Medical School, Harvard Digestive Diseases Center, Boston 02215, USA.
Gut. 1995 Sep;37(3):427-33. doi: 10.1136/gut.37.3.427.
The events that characterise recovery from severe biliary pancreatitis have not been defined. This study used a reversible model of necrotising pancreatitis, induced by obstructing the opossum common bile pancreatic duct (CBPD), to evaluate this phenomenon. The CBPD of opossums was obstructed with a balloon tipped catheter for five days and then decompressed by removal of the catheter. Recovery was evaluated 0-90 days after relief of obstruction. Serum bilirubin and amylase values rapidly declined, reaching control values 7-14 days after removal of the obstructing catheter. Pancreatic protein and amylase values were transiently increased shortly after relief of obstruction but returned to control values 21 days after decompression. Pancreatic ornithine decarboxylase activity and incorporation of [3H]-thymidine into DNA were transiently increased 14 days after duct decompression suggesting that regeneration occurs at approximately that time. Foci of pancreatic necrosis involved roughly 40% of the gland at time of decompression but these foci gradually disappeared and the gland resembled that of control animals 60 days after decompression. Evidence of fibrosis or collagen deposition in the pancreas was not noted at any time. These studies show that recovery after necrotising biliary pancreatitis occurs comparatively rapidly and the restitution ad integrum occurs. Recovery from necrotising acute pancreatitis in this model is not associated with the development of chronic pancreatitis.
严重胆源性胰腺炎恢复过程的特征性事件尚未明确。本研究采用一种由阻塞负鼠胆总管胰管(CBPD)诱导的坏死性胰腺炎可逆模型来评估这一现象。用带球囊导管阻塞负鼠的CBPD五天,然后通过移除导管进行减压。在阻塞解除后的0至90天评估恢复情况。血清胆红素和淀粉酶值迅速下降,在移除阻塞导管后7至14天达到对照值。胰腺蛋白和淀粉酶值在阻塞解除后不久短暂升高,但在减压后21天恢复到对照值。导管减压后14天,胰腺鸟氨酸脱羧酶活性和[3H] - 胸腺嘧啶核苷掺入DNA的量短暂增加,提示大约在此时发生再生。减压时胰腺坏死灶累及约40%的腺体,但这些病灶逐渐消失,减压60天后腺体与对照动物相似。在任何时候均未发现胰腺有纤维化或胶原沉积的证据。这些研究表明,坏死性胆源性胰腺炎后的恢复相对较快,且能完全恢复。该模型中坏死性急性胰腺炎的恢复与慢性胰腺炎的发生无关。