급성췌장염의 (急性膵臟炎) 병인에 (病因) 관한 실험적 연구

To elucidate pathogenesis of acute hemorrhagic pancreatitis, particularly the role of ductaI okstruction versus the specific factors in the initiation of tissue injuries in the pancreas, changes following the instillation of saline, trypsin, phospholipase A, lysolecithin, alcohol anct cholate into the pancreatic duct with or without ligation were studied. Occlus!on of pancreatic ductal flow a!one, either permanent or temporary, brought about only an elevation of serum amylase and lipase levels and edematous changes without actual tissue necrosis in the pancreas. However the instillation of trypsin, phospholipase A, lysoleci.thin, alcohol or cholate at lower pressure, even into the unobstructed pancreatic duct induced tissue necrosis in the pancreas. When the instillation of these agents into the pancreatic duct is coupled with either permanent or temporal ductal obstruction, intensive tissue necrosi.; was induced. Also, the elevation of serum amylase or lipase level after the instillation of the agents was roughly paralleled with the severit.y of pancreatic lesion induced. The elevation of the serum enzymes was more marked in anirnnls which had longer ductal occlusion of the pancreas. Therefore, it is concluded that the initiation of tissue injury is dependent upon the natuve of t4e specific agents introduced. Furthermore, the obstruction of pancreatic ductal flow merely intensifies,-nd is resporsible for the progress of the tissue damage already iuitiated. An:ong the tested injurious agents, phospholipas" A is most potent and responsible for the parenchym- atous necvosis which is a central part of acute pancreatitis, while trypsin is less potent and mainly responsible for vascular injury which brings about hemorrhage. Thus, phosphoIipn.;e A, or is split product lysolecithin, appears to stand out as the most potent and important f:ictor for the initiation of acute hemarrhagic paucreatitis. The ultrastructural changes of acinar cells following insti11ation of trypsin or phospho1ipase A into panereatic duct revealed a lytic patt- ern of endoplasmic reticulum and other organelles of the cell. However, the pattern of chan- ges induced by alcohol or cholate instillation were n",ore of a toxic nature.