TITLE:
Pathologico-Anatomic Categories of Choledochal End-Piece Stenosis Due to Chronic Pancreatitis and Clinical Significance
AUTHORS:
Yunfu Lv, Xiaoguan Gong, Xiaoyu Han, Shunwu Chang, Ning Liu, Baochun Wang
KEYWORDS:
Pancreatitis; Common Bile Duct Stenosis; Anatomicopathological Classification
JOURNAL NAME:
Open Journal of Endocrine and Metabolic Diseases,
Vol.3 No.4,
July
23,
2013
ABSTRACT:
Background: Chronic
pancreatitis caused by common bile duct segment stenosis is a common
complication. It often results in near side bile duct expansion, bile drain
disorder, appearing serious obstructive jaundice, biliary cirrhosis, lifethreatening.
However, chronic pancreatitis causes not bravery manager narrow some light, some
heavy, and the clinical manifestation is different too. We think there
may be different kinds of pathological anatomy. As a result, we
carried out the research of this subject. Objective: To
investigate the anatomicopathological classification of terminal stenosis of
the common bile duct (CBD) caused by chronic pancreatitis (CP) and the
treatment. Method: A retrospective analysis was made for the
management of sympatomatic stenosis of the terminal end of CBD 47 CP cases. Autopsy
was performed in 25 bodies to verify our classification. Result: By
analyzing operation and postoperative follow-ups to 47 patients with obvious
choledochal dilatations (diameter ≥ 15 mm) due to chronic pancreatitis, the authors
have found that there exist three pathologico-anatomic categories of
choledochal end-piece stenosis due to chronic pancreatitis. The stenosis of
type I is the external-pressing annular stricture (59.6%); type II is
front wall of choledochus being compressed one (31.9%); and type III is
the pseudocystic oppression one (8.5%). Conclusion: The
treatment of CP patients complicated with terminal stenosis of CBD need
individual consideration. Clinical
Significance: Type I should be treated with biliary-enterostomy
owing to more serious stricture (only No.3 the Bake’s
dilstors and smaller ones can be passed through its stenotic segment). Type II
Could be managed with T-tube drainage because of its slighter stricture (Bake’s
dilators bigger than No.6 and No.12 French urinary catheter can get through the
Choledochal terminal). If there aren’t biliary and pancreatic complicated diseases,
non-operative treatment can be carried out. Type III can undergo with the
T-tube replacement between biliary tract and pseudocyst if pseudocystic
decompression doesn’t lead to obvious stenosis (type IIIo and IIIb).
If type III combines type I, the internal drainage should be performed in both
ectatic bile duct and cyst.