Takács T, Czakó L, Madácsy L, Nagy F, Lonovics J
Szent-Györgyi Albert Orvostudományi Egyetem, Szeged, I. Belgyógyászati Klinika.
Orv Hetil. 1998 Nov 15;139(46):2761-4.
Pancreas divisum is the most frequent congenital ductal anomaly of the pancreas: it occurs in 5-10% of the population. In the majority of patients, this congenital anomaly is of no clinical importance. In a certain subset of patients, however, pancreas divisum is clinically important as a cause of abdominal pain, acute recurrent pancreatitis or chronic obstructive pancreatitis. The authors, experience on endoscopic drainage of the minor papilla is reported. In the history of patient 1., three episodes of recurrent pancreatitis and permanent upper abdominal pain were explored. ERP revealed a pancreas divisum and a mild irregularity and dilation of the dorsal pancreatic duct. A 7 F stent (length: 6 cm) was implanted in the dorsal pancreatic duct following a papillotomy on the stenotic minor papilla. A repeated Lundh test revealed a 58% improvement in the exocrine pancreatic function. No recurrence of pancreatitis has been observed in spite of the moderate continuous abdominal pain. In patient 2., ERP demonstrated a pancreas divisum and a severely dilated dorsal pancreatic duct as causes of the previous permanent abdominal pain. An 8 F stent (length: 5 cm) was inserted through the minor papilla without endoscopic sphincterotomy. A significant improvement in exocrine pancreatic function (70%) ensued. No abdominal pain has since been observed. In conclusion, dorsal pancreatic duct stenting (mainly in cases involving a dilated pancreatic duct) seems to have a beneficial effect in patients with both recurrent acute pancreatitis or chronic obstructive pancreatitis evoked by pancreas divisum.
在人群中的发生率为5% - 10%。在大多数患者中，这种先天性异常并无临床意义。然而，在某些患者亚组中，胰腺分裂作为腹痛、急性复发性胰腺炎或慢性阻塞性胰腺炎的病因具有临床重要性。本文报道了作者在内镜下对小乳头进行引流的经验。在患者1的病史中，曾探究过三次复发性胰腺炎发作及持续性上腹部疼痛。内镜逆行胰胆管造影（ERP）显示胰腺分裂以及背侧胰管轻度不规则和扩张。在狭窄的小乳头上进行乳头切开术后，在背侧胰管植入了一枚7F支架（长度：6 cm）。重复进行的伦德试验显示外分泌胰腺功能改善了58%。尽管仍有中度持续性腹痛，但未观察到胰腺炎复发。在患者2中，ERP显示胰腺分裂和严重扩张的背侧胰管是先前持续性腹痛的病因。未进行内镜括约肌切开术，通过小乳头插入了一枚8F支架（长度：5 cm）。外分泌胰腺功能随后有显著改善（70%）。此后未再观察到腹痛。总之，对于由胰腺分裂引起复发性急性胰腺炎或慢性阻塞性胰腺炎的患者，背侧胰管支架置入术（主要针对胰管扩张的病例）似乎具有有益效果。
