急性出血坏死性胰腺炎肠胰返流及十二指肠造瘘术治疗的实验研究

A study on duodenopancreatic reflux due to acute hemorrhagic necrotic pancreatites (AHNP) and the Therapeutic effect of duodenostomy for AHNP

用犬的自身胆汁与1％胰蛋白酶按1：1配制成复合液，注入犬的主胰管中制成急性出血性胰腺炎（AHNP）模型。结扎4只犬的十二指肠两端并向肠内注入泛影葡胺与印度墨水混合液，其中3只犬出现造影剂向胰管内返流，4只犬的胰管内均可见墨水颗粒，两只正常犬作对照检查无返流发生。20只犬制作AHNP模型的同时行十二指肠造瘘并夹闭疾管。术中及术后8、24、48小时测定十二指肠压力，结果显示AHNP形成后大的十二指肠压力迅速上升，但24小时后上升速度明显趋缓。24小时后随机开放10只犬的十二指肠造疾管，称为实验组，未开放者为对照组。结果实验组大的病死率明显低于对照组，胰腺病理改变也明显技对照组轻。本实验提示AHNP时十二指肠液容易向联管内返流；十二指肠造瘘对治疗AHNP有一定作用。

The AHNP model was established in 24 dogs by injection of a mixture of dog's biliary juice and 1 %trypsin (1:1) into pancreatic duct- A duct for duodenostomy was placed and clipped before c1osing abdomen. A closed duodenal loop was made in four dogs with AHNP. Then the mixture of urograin and Indian ink was injected into the closed loop, the pressure of which was maintained to 4 kP8. Transampullary reflux of contrast material was noted and proved fluoroscopically by abdominal X-rays in 3 dogs. The carbonic grains were found in the small pancreatic duct in 4 dogs. The reflux did not occur in two normal dogs- The pressure of duodenum had been rapid-ly increasing since AHNP occured and then, after 24 hours, the speed of increase slowed down obviouly. The ducts of duodenostomy were opened randomly in ten dogs 24 hours later (experimental group), the other ten dogs served as control group. The experimental group has a lower mortality rate (P<0.01), and less pathologic changes both in gross (P<0.05) and histological appearances (P<0.01). Our study suggests that the duo- denopancreatic reflux may be liable to occur in dogs with AHNP and aggravate the peancreatic pathologic change.Duodenostomy may play an important role in the treatment of AHNP.