T管造影合并胰管显影的临床意义

The Clinical Significance of Panereatie Duct Visualization in Choledochography Via T-tube

本文通过对１７年间行“Ｔ”管造影的１６８７例患者的系统性回顾分析，发现有２７６例患者胰管同时显影，其中６９例具有胰腺炎病史，达２５％，而无胰管显影的１０２９例患者中有１３３例具有胰腺炎病史，达１２．９％，二者间具有显著性差异。在胰管显影的病例中，发生过胰腺炎的患者其胆胰汇合角度显著高于未发生过胰腺炎患者的胆胰汇合角度（ Ｐ＜０． ００１）。作者认为：“Ｔ”管造影发生胰管同时显影的病例可能与空腹隔膜功能缺陷有关，特别是在一些因素作用下，如多种情况造成的胆总管末端梗阻时，胆汁更易这流入胰管内，造成胰腺炎。而胆胰管汇合角度大则可能是造成壶腹隔膜缺陷的重要原因。

Among 1687 patients who underwent T-tube Choledo chography during past 17 years, 279 patients had their pancreatic duct visualiged. of then , 69 cases had hisfory of pancreatitis (25 % ),while in patients without panereatic visualigation, there were only 133 cases had the hisfory of panereafitis(12. 9% ). The incidence of pancreafitis was Significantly different. befween two groups and the angks of pancretobiliary juncfion were markedly different as well (P <O. 001 ). The auther considered that the cause of pancreatic duct visualizaation is the dysfunction of ampullar septum. The dysfunction of ampullar septum can induce bile reflux to the pancreatic duct,especially when obstruction of lower portion of common bile duct appeared,which may be caused by many factors,such as gall stone impaction,oddi's sphincter spasm and edema etc. As a result of bile reflux to pancreatic duct,pancreatitis may occured and the greater junction angle of pancreaticobiliary duct may play an important role in dysfunction of ampuller septum.