慢性胰臟炎合併膽道阻塞－病例報告及文獻回顧

Chronic Pancreatitis with Biliary Obstruction: A Case Report and Literature Review

何家奭(Ka-Sic Ho) ； 蔡明宏(Ming-Hung Tsai)

《童綜合醫學雜誌》 5卷2期 (2011/12) Pp. 78-83

https://doi.org/10.29838/TMJ.201112.0006

摘要

慢性胰腺炎的特徵是胰腺組織結構性破壞及內外分泌功能之損害。胰腺炎可由各種原因導致實質局部性，節段性或瀰漫性纖維化。本文報告－46歲男性患者於住院前上腹部持續疼痛7-8天，發燒、黃疸及脂肪瀉，同時伴有血清澱粉酶及解脂酶上升。過去病史中有長期每日喝酒長達30年，吸菸數年。住院後超音波及電腦斷層檢查發現主胰管經副乳頭引流進入十二指腸，胰臟組織內有眾多結石。經內視鏡逆行性膽胰管造影術見遠端總膽管與胰臟頭部交會處因胰腺纖維化壓迫該節段膽管，造成阻塞性黃疸，經乳頭切開術，置入導管引流，病況獲得改善，病患於3天後出院。此外還發現有分裂性胰腺，主胰管經副乳頭出口至十二指腸。慢性胰腺炎之致病機轉很多，本篇將探討各種致病機轉及治療之策略。

關鍵字

慢性胰臟炎 ； 分裂性胰臟 ； 內視鏡引流術

並列摘要

Chronic pancreatitis is characterized by destruction and loss of exocrine parenchyma that may be focal, segmental, or diffuse, as well as by fibrosis of the pancreas. We reported a 46-year- old man who presented with high fever, epigastric pain for 7-8 days, marked jaundice and steatorrhea with increased of serum amylase and lipase. The patient has history of regular consumption of alcohol daily for approximately 30 years, and smoking for many years. Sonogram and computed tomography showed drainage of dorsal pancreatic duct via minor papillae, calcification of pancreas head, and dilation of proximal bile duct. The distal common bile duct that transverses the head of the pancreas was involved as a result of fibrosis of the region, and patient revealled as obstructive jaundice which was proved by endoscopic retrograde cholangiopancreatography. Besides, pancreas divisum was found on ERCP in this patient. Stricture of the common bile duct was bridged by implantation of a plastic stent after papillotomy. Patient was discharged 3 days after this procedure. Toxic metabolites, unopposed free-radical injury, and genetic mutations that promote premature activation of trypsinogen to trypsin within the acinar cell are associated with the pathogenesis of chronic pancreatitis.

並列關鍵字

Chronic pancreatitis ； Pancreas divisum ； Endoscopic drainage