What Is a Pancreatic Duct?

Duct of the exocrine pancreas. Opening in the duodenum is the main excretory duct of the pancreas. The pancreatic duct is located in the parenchymal parenchyma, close to the back of the pancreas, and runs through the entire length of the parenchyma from left to right. Most of the small ducts collecting pancreatic lobes pass through, so the diameter of the pancreas gradually increases from left to right.

Duct of the exocrine pancreas. Opening in the duodenum is the main excretory duct of the pancreas. The pancreatic duct is located in the parenchymal parenchyma, close to the back of the pancreas, and runs through the entire length of the parenchyma from left to right. Most of the small ducts collecting pancreatic lobes pass through, so the diameter of the pancreas gradually increases from left to right.

Chinese name

Pancreatic duct

Foreign name

Pancrea tictube

Pancreatic duct anatomy

On the right side of the pancreatic duct, the pancreatic duct leaves the pancreas obliquely through the posterior medial wall of the lower part of the duodenum and merges with the common bile duct, and opens together in the duodenal papilla. The pancreatic duct and common bile duct are also opened in the duodenum, but this is rare. In addition, sometimes in the upper part of the head of the pancreas, a small pancreatic duct is seen, which is curved in the bow shape, mostly above the pancreatic duct, in front of the common bile duct. The beginning of this duct often coincides with the pancreatic duct, and the end is opened separately in the duodenum nipple.

Pancreatic duct related diseases and treatment

1. Pancreatic duct stones are a rare disease, often secondary to chronic pancreatitis. In recent years, the incidence has gradually increased and often caused more serious consequences. The commonly used treatments today include endoscopic treatment and surgical treatment. The diagnosis is mainly based on imaging. an examination.

2. According to imaging data, patients with pancreatic duct stones are divided into four types:

Type stones are mainly located in the head of the pancreas with obvious narrowing or obstruction of the pancreatic ducts, fibrosis of the pancreatic head and enlargement and hardening;

Type stones are mainly located in the body of the pancreas with significant expansion of the main pancreatic duct;

Type pancreatic duct stones are mainly located in the main pancreatic duct of the pancreatic tail, which is fibrotic and adheres to the surrounding organs;

Type pancreatic duct stones are widely distributed in the head, body and tail of the pancreatic duct with obstruction of the main pancreatic duct.

3. The clinical manifestations mainly include: long-term, repetitive abdominal pain and low back pain caused by high pressure in the pancreatic duct; elevated blood glucose, fatty diarrhea, weight loss and other symptoms caused by insufficient internal and external secretion of the pancreas; Inflammatory masses can cause biliary obstruction, clinically manifested as obstructive jaundice; chronic pancreatitis with inflammatory masses, some of which appear malignant.

4.Treatment

Conservatively treated patients still have short-term and long-term curative effects because of the presence of stones in the pancreatic duct, which is only a transitional treatment.

Surgery is still the main treatment for most pancreatic duct stones today, and early surgery should be performed to save the endocrine and exocrine functions of the pancreas. The purpose of surgical treatment is to remove stones and remove lesions, remove obstructions, keep the pancreatic juices flowing smoothly, and manage biliary complications. There are many surgical methods for pancreatic duct stones, including various drainage and partial resection of the pancreas. The operation method should be determined according to the preoperative examination and intraoperative exploration. The location and distribution of stones, the presence or absence of stenosis of the pancreatic duct, and the presence or absence of pancreatic cancer are important factors in determining the operation method. The specific operation method depends on the choice. Based on the experience of the surgeon.

Taking appropriate treatments for different types of pancreatic duct stones can help improve the treatment effect.

A. Type stones and type stones should be treated with endoscope first. With the maturity of endoscopic technology and the development of endoscopic equipment, endoscopic treatment of pancreatic duct stones has gradually been understood and advocated. In developed countries such as Europe and the United States, endoscopic duodenal papillary sphincterotomy is generally promoted in the treatment of pancreatic duct stones. Lithotripsy and ultrasonic lithotripsy have the advantages of less trauma and faster recovery. However, it should be noted that endoscopic treatment of pancreatic duct stones requires more physicians' skills than bile duct stones, and the proportion of complications is higher than that of bile duct stones. The management of complications is also relatively difficult. Therefore, endoscopic treatment of pancreatic duct stones needs to be cautious, and the operator needs to be proficient in this technique.

B. For surgical treatment of pancreatic duct stones, the following points should be noted: Type stones are mainly located in the main pancreatic duct of the pancreatic head, and pancreaticoduodenectomy (Whipple surgery) is mainly used. Type stones are mainly located in the pancreatic body. The main pancreatic duct is mainly used for incision and pancreatic duct jejunal anastomosis. Type stones are mainly located in the tail of the pancreas, mainly using the tail of the pancreas plus splenectomy. Type stones are widely distributed in the main pancreatic duct of the head, body, and tail. Pancreatic head resection, large-caliber pancreatic duct incision and pancreatic duct jejunum Roux-en-Y anastomosis.