内镜综合治疗慢性胰腺炎疗效分析

目的探讨内镜在慢性胰腺炎（CP）治疗中的临床价值。方法确诊的63例CP患者,随机分成内镜组和药物组,内镜组根据患者的不同情况,采用乳头括约肌切开（EST）、胰管括约肌切开（EPST）、胰管扩张、胰管取石、鼻胰管引流（ENPD）或胰管内支架植入（PS）等术式;药物组治疗给予胰酶肠溶胶囊,疗程1年。比较两组的血淀粉酶下降时间、腹痛改善率、腹泻改善率、综合有效率。结果内镜组31例患者,术后3d血淀粉酶均下降至正常;术后1年随访发现25例患者腹痛症状改善率为80．6％;有6例腹泻术后改善率为50．0％;术后1年随访总有效率达87．1％,无复发。药物组血淀粉酶1周后缓慢下降,腹痛症状缓解率为34．4％;有5例腹泻,改善率为20．0％;1年随访总有效率15．6％。有8例复发,复发率为25．0％。两组各项结果均有显著性差异（P〈0．05）。结论内镜下治疗CP具有简单、有效、微创等优点,内镜下多种治疗方法的综合运用明显改善传统CP治疗的现状,提高了治疗水平,值得进一步推广。     

内镜下治疗慢性胰腺炎的临床疗效及对患者腹痛症状改善程度的研究

目的对内镜下治疗慢性胰腺炎(CP)的临床疗效进行观察,并分析患者腹痛症状的改善程度,为临床提供参考依据。方法选择该院2011年7月-2013年6月经内镜下治疗的CP患者81例,观察其疗效、并发症和腹痛情况。结果 81例患者手术均获成功,无死亡病例。术后1周疼痛平均分为(2.29±0.14)分,低于术前(7.13±0.27)分,差异有统计学意义(P0.05)。术后1周无痛、轻度疼痛和中度疼痛分别为46.91%(38/81)、35.80%(29/81)和13.58%(11/81),均高于术前(P0.05)。术后1周重度疼痛为3.70%(3/81),低于术前56.79%(46/81)(P0.05)。术后1周脂肪泻和营养不良分别0.00%(0/81)和7.41%(6/81),均低于术前25.93%(21/81)和37.04%(30/81),差异有统计学意义(P0.05)。术后1周血清淀粉酶平均浓度为(74.18±2.75)u/L,低于术前(182.45±8.32)u/L,差异有统计学意义(P0.05)。结论内镜下治疗CP并发症较少,疗效可靠,具有微创、可重复等优点,可有效治疗慢性胰腺炎患者并能够有效缓解其腹痛。     

胰管结石8例的外科诊治分析

目的探讨胰管结石常见症状与外科诊治方法。方法回顾性分析8例胰管结石患者的临床资料。结果腹痛、腰背痛是胰管结石摄常见症状,B超、CT、ERCP可明确诊断。5例行胰管切开取石＋胰管空肠吻合术。2例行胰十二指肠切除术,1例胰尾联合脾切除术,均治疗效果满意。结论B超可作为胰管结石的首选检查方法;胰管切开取石和胰管空肠吻合为胰管结石的主要术式。     

13例胰管内支架治疗慢性胰腺炎疗效分析

目的 探讨胰管内支架治疗慢性胰腺炎的疗效.方法 回顾性分析13例慢性胰腺炎患者的资料,患者均接受胰管内支架治疗,术后随访观察临床症状及生化检查等变化情况.结果 所有患者胰管支架放置成功,12例腹痛症状在术后1.5个月内缓解,缓解率92.31%,消瘦、脂肪泻等症状均不同程度得到改善,所有患者血清淀粉酶均于术后10 d内降至正常,1例患者于术后15 d支架阻塞更换支架.结论 胰管内支架治疗慢性胰腺炎是一种安全、微创、相对高效的方法,可有效地防止慢性胰腺炎的复发和进展.     

慢性胰腺炎临床特征分析

目的探讨慢性胰腺炎（CP）的病因、临床特点、诊断和治疗措施。方法回顾性总结2008年2月-2011年12月间住院的47例CP患者的临床诊治特点。结果47例CP患者中,胆源性24例（51．1％）,酒精性17例（36．2％）;腹部疼痛40例（87．2％）,排便次数增多及脂肪泻12例（25．5％）,糖尿病13例（27．6％）。临床症状结合超声检查基本确诊者16例（34．0％）,CT检查确诊41例（87．2％）,经内镜逆行性胰胆管造影检查确诊者31例（88．6％）。腹部X线平片发现有钙化灶者9例。以Ⅱ型和1期患者居多,分别为44．7％和51．1％,其次为Ⅳ型和3期。行手术治疗者13例（27．6％）,腹痛症状明显缓解者10例;内镜下治疗者24例（51．6％）,腹痛缓解者21例;单纯药物治疗者10例（21．2％）,药物选择胰酶制剂、质子泵抑制剂,对合并糖尿病者予以口服降糖药治疗。疼痛明显的加用止痛剂,药物治疗后平均7～14d,疼痛减轻,完全缓解4例。结论CP发病原因以胆源性为主,CP的疼痛治疗困难,需内科、内镜和外科的综合治疗。     

综合干预措施缓解重症急性胰腺炎患者疼痛

<正>疼痛已成国内、外医学界广泛认可的继体温、呼吸、血压、脉搏之后的第5大生命体征。疼痛综合护理也已成为临床护理学关注的热点。腹痛是重症急性胰腺炎(severe acute pancreatitis,SAP)的主要临床表现之一,持续时间较长,如有渗出液扩散入腹腔内可致全腹痛。重症急性胰腺炎时的腹痛可使胰腺分泌增加,肝胰壶腹括约肌痉挛加重,使业已存在的胰管或胆管内高压进一步升高,不仅给患者带来痛苦,影响患者的睡眠质量,使其机体免疫力下降;同时使患者产生明显的恐惧、焦虑、抑     

胰管狭窄内支架置入术的护理

目的探讨胰管支架置入术治疗胰管狭窄的护理方法。方法对34例胰管支架置入术患者进行术前心理护理及准备工作、术中配合操作,术后密切观察,并进行出院指导,以术后病人症状缓解率评价治疗效果。结果所有惠者均腹痛缓解,营养状态改善,症状缓解率达100%。结论有针对性地做好手术前后的护理工作是胰管支架置入术成功的重要保证。     

北京协和医院346例慢性胰腺炎人口学特征、病因变迁及临床特点

  目的  探讨慢性胰腺炎(chronic pancreatitis, CP)的人口学特征、发病病因变迁和临床特点  目的  回顾性分析1983年1月至2008年12月北京协和医院346例CP住院患者的资料, 总结其人口学特征、临床表现、病因和并发症情况  结果  346例CP患者中, 男267例, 女79例, 男:女比例为3.38:1, 发病年龄(44.34±15.88)岁。民族分布以汉族为最多(94.80%, 328/346), 职业分布以干部为最多(32.08%, 111/346)。CP患者无论是患者总数还是入院人数占同期住院患者人数的比例均呈现快速增长的趋势。酒精(40.17%)和胆石症(41.04%)是最常见的CP病因因素。不同病因类型的CP均有明显的增长, 以酒精性CP增长尤为显著, 平均年增长率为108.7%。84.39%(292/346)的患者有腹痛症状, 56.07%(194/346)的患者有体重下降, 24.86%(86/346)的患者有黄疸, 均为梗阻性黄疸。CP并发症以糖尿病最为多见, 占25.14%(87/346)。糖尿病和脂肪泻出现的病程中位时间分别在发病后1.00年和280.03个月, 自身免疫性胰腺炎出现糖尿病早于特发性胰腺炎(P=0.020)  结论  我国CP发病人数在快速增长, 酒精性CP的增长速度超过胆源性CP。腹痛与消瘦是CP最常见症状, 糖尿病是CP最常见并发症。建立CP病例资料库并进行有序随诊将有助于总结CP流行病学规律和提高诊治经验。     

体外冲击波碎石联合经内镜逆行胰胆管造影术治疗胰管结石的研究

目的探讨体外冲击波碎石术(ESWL)联合经内镜逆行胰胆管造影术(ERCP)在慢性胰腺炎(CP)合并胰管结石(5 mm)治疗中的适应证、疗效、安全性、麻醉方式和并发症。方法观察2011年11月-2016年2月,通过ESWL联合ERCP治疗的33例CP患者碎石取石的成功率、并发症情况,随访治疗后6个月和4年疗效,评估联合治疗的有效性。结果 33例患者共进行52次ESWL,碎石成功率(100.00%),ESWL联合ERCP取净结石27例(81.82%)。术后6个月和4年随访患者疼痛、脂肪泻缓解,体重增加。结论 ESWL联合ERCP治疗CP合并胰管结石安全有效。     

α_1受体阻滞剂对慢性前列腺炎并发梗阻性排尿障碍患者的疗效观察

目的 :探讨α1受体阻滞剂 (α1RB)对慢性前列腺炎 (CP)并发梗阻性排尿障碍患者的临床应用价值。方法 :治疗组 3 6例CP并发梗阻性排尿障碍患者应用α1RB治疗 ,安慰剂组 2 4例CP并发梗阻性排尿障碍患者服用同剂型安慰剂。两组同时行前列腺按摩、坐浴、口服复方新诺明。对两组治疗前后症状及尿流动力学变化进行比较。结果 :α1RB治疗组中治疗前后最大尿流率 (Qmax)从 (14 0 1± 1 46)ml/s增加到 (17 8± 1 83 )ml/s(P <0 0 1) ,前列腺症状评分 (IPSS)从 15 76± 0 3 5下降到 6 2 4± 0 2 4(P <0 0 0 1) ,对疼痛症状的缓解率为 66 7%。安慰剂组Qmax从(14 0 2± 1 2 2 )ml/s上升到 (14 92± 1 0 7)ml/s(P >0 0 5 ) ,IPSS从 15 11± 1 64下降到 13 92± 1 3 8(P >0 0 5 ) ,对疼痛症状的缓解率为 2 5 %。结论 :CP并发梗阻性排尿障碍早期是可逆性功能性梗阻 ,α1RB治疗有效 ;晚期慢性纤维化致膀胱颈梗阻 ,是一种不可逆性梗阻 ,α1RB治疗无效。α1RB除了缓解梗阻症状 ,减轻前列腺炎引起的疼痛症状外 ,其治疗效果还可作为区别后尿道功能性抑或机械性梗阻的重要参考     

Lateral pancreaticojejunostomy for pain relief in chronic pancreatitis: analysis of effectiveness in 19 patients

To assess the relief of pain provided by a side-to-side lateral pancreaticojejunostomy (LPJ), we analyzed 19 patients with chronic pancreatitis operated on from 1973 to 1983. Fourteen patients were chronic alcoholics; abdominal pain was the indication for the operation in most patients; one patient died postoperatively. The pain was relieved in all 18 survivors, from 12 to 72 months in 15; in three the pain has recurred, suggesting that LPJ is effective in ablating the pain in patients with chronic pancreatitis, provided the pancreatic duct measures more than 6 mm in diameter, the length of the LPJ is at least 6 cm, and patients abstain from alcohol ingestion. CT adequately assesses pancreatic duct dilatation. One fourth of the patients also required choledochoduodenostomy to relieve biliary obstruction caused by the chronic pancreatitis.     

Chemical pancreatectomy treats chronic pancreatitis while preserving endocrine function in preclinical models

Chronic pancreatitis affects over 250,000 people in the US and millions worldwide. It is associated with chronic debilitating pain, pancreatic exocrine failure, and high risk of pancreatic cancer and usually progresses to diabetes. Treatment options are limited and ineffective. We developed a new potential therapy, wherein a pancreatic ductal infusion of 1%–2% acetic acid in mice and nonhuman primates resulted in a nonregenerative, near-complete ablation of the exocrine pancreas, with complete preservation of the islets. Pancreatic ductal infusion of acetic acid in a mouse model of chronic pancreatitis led to resolution of chronic inflammation and pancreatitis-associated pain. Furthermore, acetic acid–treated animals showed improved glucose tolerance and insulin secretion. The loss of exocrine tissue in this procedure would not typically require further management in patients with chronic pancreatitis because they usually have pancreatic exocrine failure requiring dietary enzyme supplements. Thus, this procedure, which should be readily translatable to humans through an endoscopic retrograde cholangiopancreatography (ERCP), may offer a potential innovative nonsurgical therapy for chronic pancreatitis that relieves pain and prevents the progression of pancreatic diabetes.     

Fully covered self-expanding metal stents for refractory pancreatic duct strictures in chronic pancreatitis

Fully covered self-expanding metal stents (FC-SEMSs), which can be removed from the bile duct, have recently been used in the main pancreatic duct (MPD) in chronic pancreatitis. The aim of this study was to investigate the feasibility, safety, and efficacy of FC-SEMSs in painful chronic pancreatitis with refractory pancreatic strictures. The primary endpoints were technical success and procedure-related morbidity. Secondary endpoints were pain relief at the end of follow-up and resolution of the dominant pancreatic stricture at endoscopic retrograde pancreatography. Over 5 months, 10 patients with painful chronic pancreatitis and refractory dominant pancreatic duct strictures were treated with FC-SEMSs. All FC-SEMSs were successfully released and removed, although two stents were embedded in the MPD at their distal end and treated endoscopically without complications. Mild abdominal pain was noted in three patients after stent release. During treatment, pain relief was achieved in nine patients, but one continued to take morphine, because of addiction. Cholestasis developed in two patients and was treated endoscopically; no patient developed acute pancreatitis or pancreatic sepsis. After stent removal, the diameter of the narrowest MPD stricture had increased significantly from 3.5 mm to 5.8 mm. Patients were followed up for a mean of 19.8 months: two patients who continued drinking alcohol presented with mild acute pancreatitis; one patient developed further chronic pancreatic pain; and one had a transient pain episode. At the end of the study, nine patients no longer had chronic pain and no patients had required surgery. Endoscopic treatment of refractory MPD stricture in chronic pancreatitis by placement of an FC-SEMS appears feasible, safe, and potentially effective.     

Chronic pancreatitis patients show hyperalgesia of central origin: a pilot study.

BACKGROUND: The pain of chronic pancreatitis remains challenging to manage, with treatment all too often being unsuccessful. A main reason for this is lacking understanding of underlying mechanisms of chronic pain in these patients. AIM: To document, using somatic quantitative sensory testing, changes in central nervous system processing (neuroplasticity) associated with chronic pancreatitis pain and thus gain insight into underlying pain mechanisms. PATIENTS AND METHODS: We studied 10 chronic pancreatitis patients on stable opioid analgesic medication. Ten matched surgical patients without pain served as controls. Pain verbal numeric rating scores (NRS) and thresholds to electric skin stimulation and pressure pain were measured in dermatomes T10 (pancreatic area), C5, T4, L1 and L4. RESULTS: The pancreatitis patients had a median NRS pain score of 5 (range 3-8). Electric sensation and pain thresholds were significantly increased in the pancreatic region, tending to be more so in female pancreatitis patients. Pressure pain thresholds were significantly lower in pancreatitis patients than in controls, with men tending towards greater generalised relative hyperalgesia than women. CONCLUSIONS: Chronic pancreatitis patients show pronounced generalised deep hyperalgesia that is present despite opioid therapy. These signs, consistent with central sensitisation, appear relatively more prominent in men than women. There is also evidence suggesting that women may have a better segmental inhibitory response than men, possibly explaining their relatively less prominent generalised deep tissue hyperalgesia compared to men.     

Current advances in the management of chronic pancreatitis

Chronic pancreatitis is characterized by irreversible destruction of pancreatic parenchyma and its ductal system resulting from longstanding inflammation, leading to fibrosis and scarring due to genetic, environmental, and other risk factors. The diagnosis of chronic pancreatitis is made based on a combination of clinical features and characteristic findings on computed tomography or magnetic resonance imaging. Abdominal pain is the most common symptom of chronic pancreatitis. The main aim of treatment is to relieve symptoms, prevent disease progression, and manage complications related to chronic pancreatitis. Patients who do not respond to medical treatment or not a candidate for surgical treatment are usually managed with endoscopic therapies. Endoscopic therapies help with symptoms such as abdominal pain and jaundice by decompression of pancreatic and biliary ducts. This review summarizes the risk factors, pathophysiology, diagnostic evaluation, endoscopic treatment of chronic pancreatitis, and complications. We have also reviewed recent advances in endoscopic retrograde cholangiopancreatography and endoscopic ultrasound-guided therapies for pancreatic duct obstruction due to stones, strictures, pancreatic divisum, and biliary strictures.     

Chronic pancreatic pain successfully treated by endoscopic ultrasound-guided pancreaticogastrostomy using fully covered self-expandable metallic stent

One of the most common symptoms presenting in patients with chronic pancreatitis is pancreatic-type pain. Obstruction of the main pancreatic duct in chronic pancreatitis can be treated by a multitude of therapeutic approaches, ranging from pharmacologic, endoscopic and radiologic treatments to surgical interventions. When the conservative treatment approaches fail to resolve symptomatic cases, however, endoscopic retrograde pancreatography with pancreatic duct drainage is the preferred second approach, despite its well-recognized drawbacks. When the conventional transpapillary approach fails to achieve the necessary drainage, the patients may benefit from application of the less invasive endoscopic ultrasound (EUS)-guided pancreatic duct interventions. Here, we describe the case of a 42-year-old man who presented with severe abdominal pain that had lasted for 3 mo. Computed tomography scanning showed evidence of chronic obstructive pancreatitis with pancreatic duct stricture at genu. After conventional endoscopic retrograde pancreaticography failed to eliminate the symptoms, EUS-guided pancreaticogastrostomy (PGS) was applied using a fully covered, self-expandable, 10-mm diameter metallic stent. The treatment resolved the case and the patient experienced no adverse events. EUS-guided PGS with a regular biliary fully covered, self-expandable metallic stent effectively and safely treated pancreatic-type pain in chronic pancreatitis.     

26. Pain in Chronic Pancreatitis

Abstract: Chronic pancreatitis is defined as a progressive inflammatory response of the pancreas that has lead to irreversible morphological changes of the parenchyma (fibrosis, loss of acini and islets of Langerhans, and formation of pancreatic stones) as well as of the pancreatic duct (stenosis and pancreatic stones). Pain is one of the most important symptoms of chronic pancreatitis. The pathogenesis of this pain can only partly be explained and it is therefore often difficult to treat this symptom. The management of pain induced by chronic pancreatitis starts with lifestyle changes and analgesics. For the pharmacological management, the three‐step ladder of the World Health Organization extended with the use of co‐analgesics is followed. Interventional pain management may consist of radiofrequency treatment of the nervi splanchnici, spinal cord stimulation, endoscopic stenting or stone extraction possibly in combination with lithotripsy, and surgery. To date, there are no randomized controlled trials supporting the efficacy of radiofrequency and spinal cord stimulation. The large published series reports justify a recommendation to consider these treatment options. Radiofrequency treatment, being less invasive than spinal cord stimulation, could be tested prior to considering spinal cord stimulation. There are several other treatment possibilities such as endoscopic or surgical treatment, pancreatic enzyme supplementation and administration of octreotide and antioxidants. All may have a role in the management of pain induced by chronic pancreatitis.     

Endoscopic pancreatic sphincterotomy--technique and evaluation

Endoscopic pancreatic sphincterotomy has been developed as a new method of treatment of chronic pancreatitis in our institution since 1982. We introduced pancreatic sphincterotomy as a safe technique, after performing it successfully in 21 cases of chronic pancreatitis without any complications, and relieving both abdominal and back pain in 19 of the cases. Recently, we have added endoscopic elimination of viscid pancreatic juice including protein plugs. This report describes our procedure of pancreatic sphincterotomy in detail, and evaluates it in the endoscopic treatment of chronic pancreatitis.     

多种MRI技术联合应用鉴别诊断胰腺癌与慢性胰腺炎

目的　评价联合应用多种MRI技术在鉴别诊断胰腺癌和慢性胰腺炎中的价值。方法　回顾分析 47例胰腺癌与 2 8例慢性胰腺炎的MRI表现。MRI技术包括 :平扫FSFLASHT1WI和TSET2 WI、MR胆胰管成像 (MRCP)及多时相动态增强扫描。测量肿块与正常胰腺信号值 ,计算对比噪声比 (CNR)。结果　平扫FSFLASHT1WI和TSET2 WI对胰头癌的敏感率为 5 9.4% ,对胰体癌为 86.7% ,对慢性胰腺炎为 78.6%。MRCP对胰头癌的敏感率为 90 .6% ,对胰体癌为 6.67% ,对慢性胰腺炎为 82 .1%。多时相动态增强扫描对胰头癌的敏感率为 78.1% ,对胰体癌为 93 .3 % ,对慢性胰腺炎为85 .7%。联合应用多种MRI技术对胰头癌的敏感率为 96.9% ,对胰体癌为 93 .3 % ,对慢性胰腺炎为 92 .9% (P <0 .0 1)。结论　多种MRI技术联合运用 ,是一项对胰腺癌和慢性胰腺炎进行鉴别诊断的准确有效的方法     

Endoscopic ultrasonography: changes of chronic pancreatitis in asymptomatic and symptomatic alcoholic patients.

Changes suggestive of chronic pancreatic damage by endoscopic ultrasonography were studied in 31 asymptomatic and symptomatic alcohol abusers. Fifteen additional patients who did not drink alcohol served as controls. Eighty-nine percent (17 of 19) of the alcohol abusers with chronic abdominal pain had chronic pancreatitis by endoscopic ultrasonography. Similarly, 58%, (7 of 12) asymptomatic alcoholic patients also had changes of chronic pancreatitis on endosonography. Endoscopic ultrasonography has thus detected changes suggestive of alcohol-induced chronic pancreatic damage in up to 58% of asymptomatic alcoholic persons and in 89% of alcoholic persons with pancreatic type pain.