急性出血坏死性胰腺炎犬十二指肠液的返流

Dogs’ Duodenal Reflux in Acute Hemorrhagic Necrotizing Pancreatitis

目的：观察急性出血坏死性胰腺炎（ＡＨＮＰ）发生以后，肠胰返流是否发生。方法：向犬的胰管中注入自身胆汁和１％胰蛋白酶，制成ＡＨＮＰ模型，关腹前行十二指肠造瘘并夹闭造瘘管。对４只ＡＨＮＰ犬和４只对照犬，向十二指肠闭袢内注入泛影葡胺和印度墨水的混合液，保持十二指肠压力为４ｋＰａ，观察是否有肠胰返流发生，并测量十二指肠压力变化。结果：４只ＡＨＮＰ犬中３只胰管显影，组织学切片观察４只ＡＨＮＰ犬的小胰管中均有墨水颗粒，但４只对照犬未见返流发生。ＡＨＮＰ发生以后，十二指肠内压迅速升高。结论：ＡＨＮＰ发生以后，由于肝胰壶腹括约肌功能障碍和十二指肠内高压。

Objective:This investigation was designed to ascertain whether duodenal reflux exists after acute hemorrhagic necrotizing pancreatitis (AHNP) has occurred. Methods:The AHNP model was established in 16 dogs by injection of a mixture of dog's bile and 1% trypsin(1∶1) into pancreatic duct,and the other 4 dogs were made as control group. A closed duodenal loop was made in four AHNP dogs and in four control dogs. Then the mixture of urograin and Indian ink was injected into the closed loop, the pressure of which was maintained as 4 kPa. The abdomen was frequently fluoroscoped for evidence of reflux. In the other 12 AHNP dogs, we observed alteration of duodenal pressure. Results: In 3 of 4 AHNP dogs, transampullary reflux of contrast material was noted fluoroscopically and documented by abdominal X-rays. These results were agreed with the findings of carbonic grain in histological examination in each of 4 AHNP dogs. But the reflux didn't occur in 4 control dogs. The duodenal pressure has been rapidly increasing since AHNP occurred. Conclusion: Duodenal contents may consistantly reflux into pancreatic duct following AHNP due to the dysfunction of Oddi's sphincter and high pressure in duodenum.