慢性胰腺炎诊治指南(2014版)

Guidelines for the diagnosis and treatment of chronic pancreatitis (2014 edition)

  • 摘要: 慢性胰腺炎发病率逐年升高,酗酒是主要致病因素,腹痛及胰腺内、外分泌功能不全为主要临床表现。诊断主要依据临床表现和影像学检查。增强CT检查是首选检查方法。胰腺活组织检查可确定诊断,但不推荐常规采用。非手术治疗包括戒烟戒酒、调整饮食结构、补充胰酶制剂、控制血糖及镇痛等。自身免疫性胰腺炎首选糖皮质激素治疗。内镜技术为慢性胰腺炎治疗提供新的途径,但远期疗效不及手术治疗好。外科治疗遵循个体化原则,手术方式有胰管引流手术(Partington术);各种胰腺切除手术包括Whipple术、保留幽门胰十二指肠切除术(PPPD)、胰体尾切除术、中段胰腺切除术和全胰切除术;联合术式(胰腺切除联合引流手术)是有效的手术方式,包括Beger术及改良术式、Frey术、Izbicki术和Berne术。患者术后需要定期随访。

     

    Abstract: The incidence of chronic pancreatitis (CP) is increasing recently. The major risk factor of CP is alcohol drinking. Abdominal pain and insufficiency of exocrine and endocrine function are the common clinical manifestations. The primary diagnosis is based on the clinical features and imaging findings, and contrastenhanced CT is the method of choice. The results of biopsy could present the definite diagnosis, but are not recommended for routine application. Conservative treatments include alcohol abstinence, alteration of diet, pancreatic enzymes replacement, blood glucose control and analgesia. Glucocorticoids are the first line of therapy for autoimmune pancreatitis. Endoscopic intervention provides new methods for management of CP, however, the longterm outcome is inferior to that of surgery. Surgical therapy depends on individualization, including pancreatic duct drainage (Partington procedure), different pancreatectomies procedures, such as Whipple′s procedure, pyloruspreserving pancreaticoduodenectomy (PPPD), distal pancreatectomy, middle segmental pancreatectomy and total pancreatectomy. A combined procedure of drainage and local resection of the inflamed tissue could be an effective treatment, including Beger procedure and its modified methods, Frey  procedure,Izbicki procedure and Berne procedure. The postoperative regular followup is recommended.

     

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