COMPARATIVE RADIOLOGICAL AND MORPHOLOGICAL-STUDY OF HUMAN-PANCREAS - PANCREATITIS LIKE CHANGES IN POSTMORTEM DUCTOGRAMS AND THEIR MORPHOLOGICAL PATTERN - POSSIBLE IMPLICATION FOR ERCP
COMPARATIVE RADIOLOGICAL AND MORPHOLOGICAL-STUDY OF HUMAN-PANCREAS - PANCREATITIS LIKE CHANGES IN POSTMORTEM DUCTOGRAMS AND THEIR MORPHOLOGICAL PATTERN - POSSIBLE IMPLICATION FOR ERCP
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DOI：
10.1136/gut.26.4.406
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发表时间：
1985-01-01
期刊：
影响因子：
24.5
通讯作者：
WIENBECK, M
中科院分区：
文献类型：
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作者：
SCHMITZMOORMANN, P;HIMMELMANN, GW;WIENBECK, M
对69例无慢性胰腺炎临床或组织学征象的人胰腺进行了导管造影和组织学检查。由6名熟练的内窥镜逆行胰管造影术(ERCP)的临床医生独立评估，通过简单评分、强迫选择评分和确定慢性胰腺炎的分级来评估改变的程度。用半定量方法检测导管内上皮细胞增殖、导管周围、小叶内和小叶周围纤维化、导管内蛋白堵塞和脂肪坏死的数量。6种导管造影评价在数据水平上有显著差异，但在分布范围上一致。对于慢性胰腺炎患者的导管造影判断，所有的评估都是正确的。然而，没有慢性胰腺炎的患者也经常被归类为慢性胰腺炎；总体上占81%(轻度37%，中度33%，重度11%)。这种高水平的假阳性诊断表明，在没有慢性胰腺炎的患者中，主管及其侧支的胰炎样病变的频率很高。导管病变与小叶周围纤维化显著相关。这一发现支持这样的假设，即在非炎症胰腺中，小叶周围纤维化在导管改变的发展中起关键作用，就像在慢性胰腺炎中一样。小叶周围纤维化可能是由年龄依赖性导管内上皮细胞增生引起的小叶内炎症所致。
A postmortem study by ductography and histology was performed on 69 human pancreata with no clinical or histological signs of chronic pancreatitis. The ductograms, supplemented by 5 postmortem ductograms of chronic pancreatitis, were independently evaluated by 6 clinicians skilled in ERCP [endoscopic retrograde pancreatography]; the degree of alteration was estimated by simple rating, forced choice rating and by determination of the grade of chronic pancreatitis. Histologically, the amount of intraductal epithelial proliferation, periductal, intralobular and perilobular fibrosis, intraductal protein plugs and fat necrosis was determined by semiquantitative methods. The 6 ductographical evaluations significantly differed in the level of their data, but corresponded in the range of distribution. All evaluations were correct regarding judgment of ductograms from patients with chronic pancreatitis. Ductograms of patients without chronic pancreatitis, however, were also frequently classified as chronic pancreatitis; overall 81% (minimal 37%, moderate 33%, severe 11%). This high level of false positive diagnosis indicates the frequency of pancreatitis-like lesions in the main duct and its side branches in patients without chronic pancreatitis. Ductal lesions were significantly correlated with perilobular fibrosis. This finding favors the assumption that in the non-inflamed pancreas, perilobular fibrosis plays a key role in the development of ductal alterations, as in chronic pancreatitis. Perilobular fibrosis may result from intralobular inflammation caused by age-dependent intraductal epithelial hyperplasia.