胰腺分裂在慢性胰腺炎病因学中的作用及其发病机制  

An Experimental Study on the Etiologic Effect of Pancraes Divisum on Chronic Pancreatitis and the Pathogenesis

作　　者：梁林[1] 冯凯琳[1] 吕维富[2] 

机构地区：[1]天津武警医学院放射教研室,天津300162 [2]安徽省立医院放射科

出　　处：《实用放射学杂志》2000年第9期522-524,共3页Journal of Practical Radiology

摘　　要：目的 :探讨胰腺分裂 (PD)在慢性胰腺炎病因学中的作用及其发病机制。方法 :将 32只犬随机分为 4组 (每组 8只 ) :部分结扎背 -腹胰管间的交通支。 a组 :切断并结扎交通支。 b组 :在背胰管注入小乳头前 2 mm处将其切断并结扎断端。 组 :除不结扎交通支外余同上。于手术前检测各组犬血清磷脂酶 (PL A2 )和淀粉酶 (Ams)活性及背、腹胰管基础压并在胰泌素激发后15、30、45、6 0和 90 min各测压一次。于术后 180 d再行胰胆管测压和造影并观察背、腹胰和十二指肠乳头的病理改变。结果 :(1) 、 a组和 b组术后 5～ 80 d血清 PL A2 和 Ams活性显著升高。 (2 )处死时 、 a组腹胰管和 b组背、腹胰管压力在激发后 30～6 0 min显著高于注药前 (P<0 .0 1) ;在 6 0 min后 ,前两组压力恢复到术前水平 (P>0 .0 5 ) ,而 b组仍较高 (P<0 .0 5 ) ,该组压力在90 min后恢复正常。 (3)光镜 : b组犬背、腹胰小叶间或 /和胰管周围显著纤维组织增生 ,腺细胞结构破坏和炎细胞浸润。 和 a组腹胰呈轻度上述改变。 (4)电镜 : 、 a组腹胰和 b组背、腹胰腺细胞粗面内质网脱颗粒、融合和扩张。酶原颗粒减少 ,线粒体肿胀。 和 a组背胰及 组背、腹胰未见异常。结论 :PD是慢性胰腺炎的病因学因素之一 。Objective:To explore the etiologic effect of pancreas divisum(PD) on chronic pancreatitis and the pathogenesisMethods:A canine model of PD was established in 32 dogs.The dogs were randomly divided into 4 groups(n=8).Group Ⅰ:The communicating branch between the dorsal and ventral pancreatic duct was partly ligated remainding a 1.0 mm diameter.Group Ⅱa:The communicating branch was amputated and competely ligated.GroupⅡb:The dorsal duct was amputated and ligated at 2 mm distance to the minor papilla.GroupⅢ:A sham operation without any amputation or ligation was performed.Before and after operation,the activities of serum phospholipase A2(PLA2)and amylase(Ams)were assayed and the basal pressures of the duct were measured when secretin was injected.Pancreatic ductography and the pathologic examination were performed.Results:(1)The activities of serum PLA2 and Ams in Group Ⅰ,Ⅱ a and Ⅱb were significantly increased 5-80 days after operation.(2)At sacrifice,the basal pressures of the ventral duct were significantly increased 30～60 min after provocation in Group Ⅰ,Ⅱa and Ⅱb,especially in Group Ⅱb,the pressures returned to the normal level till 90 min.The pressures of the dorsal duct were significantly increased in Group Ⅰb but no difference in Group Ⅰ and Ⅱa.(3)Light microscope:The fibrosis of interlobus and periducts,the destruction of acini and infiltration of inflammatory cell in dorsal and ventral pancreas were found in Group Ⅱb.But in Group Ⅰ and Ⅱa,this findings were present only in the ventral pancreas.(4)Electron microscope:In ventral pancreas of Group Ⅰ and Ⅱa and the dorsal and ventral pancreas of Group Ⅱb,the rough endoplasmic reticulum of the acinar cells showed granules-scaling,fusion and dilatation.The zymogen granules decreased and the mitochondria was swollen.Conclusion:A difinite etiologic relationship was confirmed between PD and chronic pancreatitis.The pathogenesis was due to the functional obstruction of the minor papilla at the peak stage of secretion. [

关 键 词：病因学 动物实验 慢性胰腺炎 胰腺分裂 

分 类 号：R657.510.2[医药卫生—外科学] R657.53[医药卫生—临床医学]