改良胰管结石分型在慢性胰腺炎中的应用

The application of modified pancreatic duct stone classification in chronic pancreatitis

  • 摘要: 慢性胰腺炎是一种以胰腺组织进行性纤维化为特征的慢性炎症性疾病,其病理学特征主要表现为胰腺实质纤维化、胰管结石或钙化沉积,以及胰管节段性狭窄与扩张。长期慢性炎症刺激不仅会导致胰腺功能进行性损害,还可能诱发胰腺假性囊肿形成,甚至癌变风险。在慢性胰腺炎的综合治疗中,清除胰管结石、恢复胰管引流通畅以及保护剩余胰腺功能是临床治疗的核心目标。传统的治疗策略主要基于创伤递进式原则和早期外科手术干预理念。近年来,随着体外冲击波碎石术技术的革新,经内镜逆行胰胆管成像联合胆道子镜直视下激光碎石等新技术的应用,以及保留胰腺功能外科手术方式的改进,慢性胰腺炎的治疗面临“创伤递进式策略与早期外科手术干预孰优”的争议。在此背景下,西安交通大学胰腺疾病诊疗中心(以下简称“西胰”)治疗模式应运而生,该模式强调根据胰管结石类型,采用个性化多模式治疗策略,整合碎石、内镜治疗以及外科手术等多种治疗手段,以实现精准治疗。笔者团队基于对国内外胰管结石分型系统的综合分析,并结合慢性胰腺炎领域超过1 000例的临床诊断与治疗经验,进一步优化并提出“西胰”治疗模式下的胰管结石分型体系。该分型体系旨在通过细化结石特征,指导个体化治疗决策,从而提高慢性胰腺炎的综合诊断与治疗水平,为临床实践提供更为科学的理论依据和实践参考。

     

    Abstract: Chronic pancreatitis is a chronic inflammatory disease characterized by progre-ssive fibrosis of pancreatic tissue. Its pathological features primarily include parenchymal fibrosis, intraductal stone formation or calcification deposits, as well as segmental stenosis and dilation of the pancreatic duct. Prolonged chronic inflammatory stimulation not only leads to progressive pancreatic dysfunction but may also trigger the formation of pancreatic pseudocysts and even malignant transformation. In the comprehensive treatment of chronic pancreatitis, the core clinical goals are the removal of pancreatic duct stones, restoration of unobstructed pancreatic duct drainage, and preservation of residual pancreatic function. Traditional treatment strategies have been based on the principle of progressive intervention and early surgical management. In recent years, with advancements in extracorporeal shock wave lithotripsy, the application of new techniques such as endoscopic retrograde cholangiopancreatography combined with laser lithotripsy under direct cholan-gioscopic visualization, and improvements in pancreas‑preserving surgical approaches, the debate over the superiority of progressive intervention versus early surgical treatment has intensified. Against this backdrop, the treatment mode of Xi′an Jiaotong University Pancreatic Disease Center (hereinafter referred to as "Western Pancreas") has emerged, emphasizing a personalized, multimodal treatment strategy based on different types of pancreatic duct stones. The treatment mode of "Western Pancreas" integrates lithotripsy, endoscopic treatment, and surgical interventions to optimize patient outcomes. By conducting a comprehensive analysis of domestic and international pancreatic duct stone classi-fication systems and drawing from our team′s clinical experience in managing over a thousand cases of chronic pancreatitis, the authors have further refined and proposed a classification system for pancreatic duct stones under the treatment mode of "Western Pancreas". This refinement aims to enhance the overall diagnostic and therapeutic standards for chronic pancreatitis.

     

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