Reber P U, Patel A G, Lewis M P, Ashley S W, Reber H A
Department of General Surgery, UCLA School of Medicine, USA.
Surgery. 1998 Sep;124(3):561-7.
In humans with chronic pancreatitis (CP), pancreatic interstitial pressure (IP) is elevated and pancreatic blood flow (PBF) is reduced. The efficacy of surgical decompression (SD) of the pancreatic duct (ie, pancreaticojejunostomy) is believed to be due to its ability to decrease IP and pancreatic vascular resistance (Rp), which increases PBF. Pancreatic duct stenting (STE) also probably reduces IP and Rp, which may explain its efficacy. The purpose of this study was to compare the efficacy of SD with STE.
CP in cats was created by narrowing the main pancreatic duct. Six weeks later, CP and normal pancreata were isolated and perfused ex vivo under basal conditions and after secretin stimulation. In normal and CP glands, IP and perfusion pressure were measured and Rp (U) was calculated. In two additional groups, the pancreatic duct was decompressed, either by stenting or by complete transection of the duct with a longitudinal capsulotomy.
In CP glands, IP and Rp were increased and secretory output was markedly reduced compared with the normal (0.65 +/- 0.30 mm Hg and 0.46 +/- 0.04 U vs 3.90 +/- 0.80 mm Hg and 1.68 +/- 0.05 U; P < .05). Secretin administration (2 units) increased IP and Rp in CP glands (6.60 +/- 1.10 mm Hg and 2.87 +/- 0.07 U; P < .05), but these values did not chang in normal glands (0.81 +/- 0.20 and 0.53 +/- 0.03 U; NS). STE and SD decreased IP and Rp in CP glands (2.20 +/- 0.20 to 1.0 +/- 0.40 mm Hg and 1.20 +/- 0.015 to 0.90 +/- 0.01 U, respectively; P < .05). Both methods prevented an increase of IP and Rp after secretin administration. IP and Rp decreased to a greater degree following SD, compared with STE (P < .05).
Both STE and SD decreased IP and Rp in this experimental model of CP. However, SD was significantly more effective than STE.
在慢性胰腺炎（CP）患者中，胰腺间质压力（IP）升高，胰腺血流（PBF）减少。胰管手术减压（SD，即胰管空肠吻合术）的疗效被认为是由于其能够降低IP和胰腺血管阻力（Rp），从而增加PBF。胰管支架置入术（STE）可能也会降低IP和Rp，这或许可以解释其疗效。本研究的目的是比较SD与STE的疗效。
通过使猫的主胰管变窄来制造CP。六周后，分离出CP胰腺和正常胰腺，并在基础条件下以及在促胰液素刺激后进行离体灌注。在正常和CP腺体中，测量IP和灌注压力，并计算Rp（U）。在另外两组中，通过支架置入或通过纵向包膜切开术完全横断胰管来对胰管进行减压。
与正常情况相比，CP腺体中的IP和Rp升高，分泌量显著减少（分别为0.65±0.30 mmHg和0.46±0.04 U，而正常情况为3.90±0.80 mmHg和1.68±0.05 U；P<.05）。给予促胰液素（2单位）会使CP腺体中的IP和Rp升高（分别为6.60±1.10 mmHg和2.87±0.07 U；P<.05），但这些值在正常腺体中没有变化（分别为0.81±0.20和0.53±0.03 U；无显著性差异）。STE和SD均降低了CP腺体中的IP和Rp（分别从2.20±0.20 mmHg降至1.0±0.40 mmHg，从1.20±0.015 U降至0.90±0.01 U；P<.05）。两种方法均能防止促胰液素给药后IP和Rp的升高。与STE相比，SD后IP和Rp下降的程度更大（P<.05）。
在这个CP实验模型中，STE和SD均降低了IP和Rp。然而，SD比STE显著更有效。
