头端胰管梗阻与胰管结石

在胰管结石（ＰＤＣ）手术的１１例中．发现有主胰管近端梗阻伴十二指肠乳头和Ｖａｔｅｒ壶腹部狭窄各１例．主胰管狭窄８例．副胰管近端开口狭窄１例。胰管近端梗阻的诊断依据是在ＥＲＣＰ检查时，成功插管入十二指肠乳头．而造影胰管不能显示。逆行性细菌感染在形成ＰＤＣ的核心中起一定作用。还讨论了ＰＤＣ的临床症状．诊断，病理学改变和治疗。

Obstruction of proximal pancreatic duct and the formation of calculi

The pathogenesis of pancreaticduct calculi(PDC) has not yet been fully clarified.The obstruction of Wirsung's duct proximalto the calculi was discovered during operation in11 cases,of whom the stenosis of the orifice ofduodenal papilla and ampulla of Vater werefound in each case and the stenosis of wirsung'sduct in & cases. In addition a coexisted calculusin Santorini's duct distal to the orifice stencoiswas found in 1 case.Secondary calculi might befound in dilated pancreatic duct (PD)distal tothe primary calculi.The obstruction of proximalPD was also shown with nonvisualization of PDafter successful catheterization of duodenalpepilla in ERCP for 9 cases. The insufficientsynthesis of pencreatic stone protein resulted incrystalization and precipitatin of calcium bicarbonate in pacreatic juice in chronic pancreatitisdue to acinar damage. The retrogfade bacterialinfection in PD form the gut aggravated the acinar and ductal injury as shown in this report.The falling off epithelial cells and concentratedmucus in pancreatic juice might be the corewhich provided the precipitation of calcium saltand contributed to the formation of stone. Theclinical features, diagnosis, pathological changesand the principle of treatment for these patientswere presented and discussed.