Nattermann C, Goldschmidt A J, Dancygier H
Department of Internal Medicine II, Municipal Clinic Offenbach, J. W. Goethe-Universität Frankfurt/Main, Germany.
Endoscopy. 1993 Nov;25(9):565-70. doi: 10.1055/s-2007-1010406.
Endoscopic ultrasonography (EUS) and endoscopic retrograde pancreatography (ERP) were prospectively performed in 114 patients, 94 of whom (62 men, mean age 53 years) had inflammatory pancreatic disease, either chronic pancreatitis or status post acute edematous pancreatitis. Twenty patients (14 men, mean age 54 years) who were examined for other reasons and who had a normal ERP served as controls. EUS was performed in most cases with the knowledge of ERP results which had been classified according to the Cambridge classification system of chronic pancreatitis as being grade 0 (normal) or 1-3 (inflammatory changes). Parenchymal and ductal changes on EUS were correlated with the ERP changes. Abnormal EUS features were found in all patients with grade 2 and 3 chronic pancreatitis, in 88% with stage 1, and in 63% of cases with a normal ERP as well. These changes were, however, not detectable in any of the 20 control cases. Among the EUS features of chronic pancreatitis, diffuse changes predominated (stage 1: 75%, 2: 88%, 3: 96%) and consisted mainly of alternating echopoor and echorich areas and of a lobulated parenchymal pattern. In 80% of patients, these findings were combined with an irregular pancreatic margin. Changes of the main pancreatic duct were found in stages 2 and 3 in 81% and 96%, respectively; isolated side branch alterations, as detected mainly in stage 1 chronic pancreatitis on ERP, escaped endosonographic visualization. We conclude that EUS shows inflammatory changes in almost all patients in whom ERP suggests chronic pancreatitis. EUS, however, is also positive in a considerable number of cases with normal ERP but who have a clinical episode of pancreatic inflammation.(ABSTRACT TRUNCATED AT 250 WORDS)
对114例患者进行了前瞻性内镜超声检查（EUS）和内镜逆行胰胆管造影（ERP），其中94例（62名男性，平均年龄53岁）患有炎性胰腺疾病，包括慢性胰腺炎或急性水肿性胰腺炎后状态。20例（14名男性，平均年龄54岁）因其他原因接受检查且ERP结果正常的患者作为对照。大多数情况下，EUS检查是在知晓ERP结果的情况下进行的，ERP结果已根据慢性胰腺炎的剑桥分类系统分为0级（正常）或1 - 3级（炎性改变）。EUS上的实质和导管改变与ERP改变相关。在所有2级和3级慢性胰腺炎患者中均发现EUS特征异常，1级患者中有88%，ERP正常的患者中也有63%出现异常。然而，在20例对照病例中均未检测到这些改变。在慢性胰腺炎的EUS特征中，弥漫性改变占主导（1级：75%，2级：88%，3级：96%），主要表现为低回声和高回声区域交替以及实质呈分叶状。80%的患者中，这些表现伴有胰腺边缘不规则。主胰管改变在2级和3级患者中分别为81%和96%；孤立的分支改变主要在1级慢性胰腺炎的ERP检查中发现，内镜超声未观察到。我们得出结论，EUS在几乎所有ERP提示慢性胰腺炎的患者中均显示炎性改变。然而，在相当数量ERP正常但有胰腺炎症临床发作的病例中，EUS也呈阳性。（摘要截短于250字）
