A special form of segmental pancreatitis: "groove pancreatitis".
A special form of segmental pancreatitis: "groove pancreatitis".
复制标题
节段性胰腺炎的一种特殊形式：“沟道胰腺炎”。
作者：
M. Stolte;W. Weiss;H. Volkholz;W. Rösch
“沟状胰腺炎”是一种影响胰腺头部的节段性胰腺炎，它位于器官头部，十二指肠和胆总管之间的“沟”内。我们在123例慢性胰腺炎手术十二指肠胰切除术标本中诊断出这种形式的胰腺炎（24.4%）。在与非节段性慢性胰腺炎的比较中，在年龄和性别分布或饮酒方面没有观察到差异。相比之下，在临床上，胆道系统疾病、消化性溃疡和胃切除术更常见。主要临床表现为十二指肠狭窄；在超声和CT检查中，“沟”内的瘢痕“板”表示“肿瘤”，因此，也由于十二指肠狭窄的频繁发生，可能怀疑是胰头癌。沟槽性胰腺炎，胰管系统大体正常，钙化或导管内蛋白栓罕见，胰腺内动脉和小动脉的适应性内膜纤维化仅在瘢痕区可见。常见的是十二指肠壁瘢痕、十二指肠狭窄、真十二指肠壁和胰腺囊肿。病因可能为胆道系统既往疾病、消化性溃疡、胃切除术、真十二指肠壁囊肿、胰头囊肿、十二指肠胰腺异位引起的胰腺炎、小乳头缺失时胰液流出圣托里尼管紊乱以及慢性酒精中毒引起的过度刺激。
"Groove pancreatitis" is a form of segmental pancreatitis affecting the head of the pancreas which is localized within the "groove" between the head of the organ, the duodenum and the common bile duct. We diagnosed this form of pancreatitis in 30 out of 123 surgical duodenopancreatectomy specimens of chronic pancreatitis (24.4%). In a comparison with non-segmental chronic pancreatitis, no differences was observed in age and sex distribution or in alcohol consumption. Clinically, in contrast, preceding diseases of the biliary system, peptic ulcers and gastric resections were more frequently indicated. The cardinal clinical finding is frequently duodenal stenosis; in sonographic and CT examinations, the cicatricial "plate" in the "groove" represents as a "tumor", so that--also on account of the frequent duodenal stenosis--a carcinoma of the head of the pancreas may be suspected. In groove pancreatitis, the pancreatic duct system is grossly normal, calcifications or intraductal protein plugs being rare and an adaptive intimal fibrosis of the intrapancreatic arteries and arterioles is found only within the cicatricial area. Very commonly, scarring of the duodenal wall, stenosis of the duodenum, true duodenal wall and pancreatic cysts are detected. Aetiopathogenetic possibilities are previous diseases of the biliary system, peptic ulcers, gastric resections, true duodenal wall cysts, pancreatic head cysts, pancreatitis in duodenal pancreatic heterotopia, and disturbances of pancreatic juice outflow in Santorini's duct in the absence of the minor papilla, and hyperstimulation in consequence of chronic alcoholism.