Glaser J
Medizinische Klinik, Herz-Jesu-Krankenhaus Fulda, Germany.
Z Gastroenterol. 1997 Jul;35(7):579-83.
The normal-sized pancreatic duct can be demonstrated today by sonography in about 90% of all persons examined. In healthy individuals intravenous bolus injection of secretin generally leads to a short-lasting distinct dilatation of Wirsung's duct being likewise visible on ultrasonography. Further investigations showed no or only a slight secretin-induced pancreatic duct dilatation in chronic pancreatitis, whereas patients with papillary or pancreatic duct stenosis had a marked and prolonged duct enlargement after stimulation. Different authors reported a high sensitivity and specificity of this sonographic secretin test in the diagnosis of chronic pancreatitis, even in early stages. In patients with pancreas divisum the secretin test result seems to be less uniform, a marked and prolonged duct enlargement after secretin stimulation, however, has been successfully used as a diagnostic criterion of accessory sphincter obstruction. Recently this test method has also been used to differentiate the etiology of cystic pancreatic lesions under observation by endoscopic ultrasonography. Since sonographic measurement of the pancreatic duct diameter before and after secretin stimulation is easy to perform with modern technical equipment, it could be a useful screening test for different diagnostic questions in pancreatic disease. Further investigations are needed for the evaluation of its reliability and standardization.
如今，超声检查可在约90%的受检者中显示正常大小的胰管。在健康个体中，静脉推注促胰液素通常会导致维尔松氏管出现短暂的明显扩张，超声检查同样可见。进一步研究表明，慢性胰腺炎患者在促胰液素刺激后胰管无扩张或仅有轻微扩张，而乳头或胰管狭窄患者在刺激后则出现明显且持久的胰管扩张。不同作者报道，这种超声促胰液素试验在慢性胰腺炎诊断中具有较高的敏感性和特异性，甚至在早期阶段也是如此。在胰腺分裂症患者中，促胰液素试验结果似乎不太一致，然而，促胰液素刺激后明显且持久的胰管扩张已成功用作副括约肌梗阻的诊断标准。最近，这种检测方法也被用于通过内镜超声检查鉴别观察中的胰腺囊性病变的病因。由于使用现代技术设备很容易在促胰液素刺激前后对胰管直径进行超声测量，因此它可能是一种针对胰腺疾病不同诊断问题的有用筛查试验。需要进一步研究以评估其可靠性和标准化。
