Cameron J L, Kieffer R S, Anderson W J, Zuidema G D
Ann Surg. 1976 Nov;184(5):587-93. doi: 10.1097/00000658-197611000-00009.
Thirty-four patients seen over a 10-year period with internal pancreatic fistulas are reported. In 22 patients the fistula was into the peritoneal cavity and they presented with pancreatic ascits. In 7 patients the fistula tracked up through the mediastinum into a pleural cavity, and they presented with pancreatic pleural effusions. Five patients presented with both pancreatic ascites and pancreatic pleural effusions. Diagnosis was made by finding a markedly elevated amylase and protein content in the ascitic and pleural fluids. Serum amylase was usually, but not always, elevated. Over one half of the patients had no history of inflammatory pancreatic disease. Initial treatment was non-operative using nasogastric suction, diamox, atropine, and multiple paracenteses or thoracenteses. This was successful in 48% (12/25). If non-operative therapy failed, surgery was performed to drain or resect the internal fistula. Surgery was successful in 82% (14/17). The internal pancreatic fistula was successfully demontrated in most instances by preoperative, operative, or postmortem pancreatography, or by gross observation at the time of surgery.
本文报告了在10年期间诊治的34例胰腺内瘘患者。22例患者的瘘口通向腹腔，表现为胰源性腹水。7例患者的瘘管经纵隔向上进入胸腔，表现为胰源性胸腔积液。5例患者同时出现胰源性腹水和胰源性胸腔积液。通过检测腹水和胸腔积液中淀粉酶和蛋白质含量显著升高来确诊。血清淀粉酶通常升高，但并非总是如此。超过一半的患者无胰腺炎症病史。初始治疗采用非手术方法，包括鼻胃管抽吸、乙酰唑胺、阿托品以及多次腹腔穿刺或胸腔穿刺。48%（12/25）的患者治疗成功。如果非手术治疗失败，则进行手术引流或切除内瘘。手术成功率为82%（14/17）。在大多数情况下，术前、术中或尸检胰管造影，或手术时肉眼观察可成功显示胰腺内瘘。
