Widdison A L, Karanjia N D, Reber H A
Department of Surgery, VA Medical Center, Sepulveda, California.
Gut. 1994 Sep;35(9):1306-10. doi: 10.1136/gut.35.9.1306.
The routes of spread of pathogens into the pancreas in acute pancreatitis were investigated. Four experiments were performed: (1) cats with and without acute pancreatitis were given 10(7) Escherichia coli (E coli) intravenously, (2) in cats with acute pancreatitis 10(8) E coli was placed in the colon. In half of them the colon was then enclosed in an impermeable bag to prevent transmural spread. (3) E coli (10(4)) was placed in the pancreatic duct in cats with and without acute pancreatitis. (4) In cats with acute pancreatitis 10(5) E coli was placed in the gall bladder. In half of them the common bile duct was ligated to prevent biliary-pancreatic reflux. After 24 hours, intravenous E coli infected the pancreas in six of nine cats with acute pancreatitis and three of 10 controls. After 72 hours E coli spread to the pancreas from the colon in six of nine cats with acute pancreatitis. This was prevented by enclosing the colon in an impermeable bag (p = 0.02). In five of six cats with acute pancreatitis and five of six controls E coli placed in the pancreatic duct colonised the pancreas within 24 hours. Pancreatic colonisation from the gall bladder occurred in five of six cats with a patent common bile duct and in three of six with an obstructed common bile duct. In conclusion, in cats E coli can spread to the pancreas by the blood stream, transmurally from the colon, and by reflux into the pancreatic duct.
对急性胰腺炎中病原体侵入胰腺的途径进行了研究。进行了四项实验：（1）给患有和未患有急性胰腺炎的猫静脉注射10⁷大肠杆菌（E coli），（2）在患有急性胰腺炎的猫的结肠中放置10⁸大肠杆菌。其中一半猫的结肠随后被置于一个不透水的袋子中以防止穿壁扩散。（3）在患有和未患有急性胰腺炎的猫的胰管中放置大肠杆菌（10⁴）。（4）在患有急性胰腺炎的猫的胆囊中放置10⁵大肠杆菌。其中一半猫的胆总管被结扎以防止胆胰反流。24小时后，静脉注射的大肠杆菌在9只患有急性胰腺炎的猫中有6只感染了胰腺，在10只对照猫中有3只感染。72小时后，大肠杆菌在9只患有急性胰腺炎的猫中有6只从结肠扩散到了胰腺。通过将结肠置于不透水的袋子中可防止这种情况发生（p = 0.02）。在6只患有急性胰腺炎的猫中有5只以及6只对照猫中有5只，置于胰管中的大肠杆菌在24小时内定植于胰腺。在胆总管通畅的6只猫中有5只以及胆总管梗阻的6只猫中有3只，大肠杆菌从胆囊定植于胰腺。总之，在猫中，大肠杆菌可通过血流、从结肠穿壁以及反流进入胰管扩散到胰腺。
