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1.
目的 建立我国慢性胰腺炎(CP)流行病学、病因、临床表现、诊断以及治疗数据库,并研究我国CP流行病学特征、病因和危险因素,以及临床表现、诊断和治疗现状,指导我国CP诊治.方法 采用多中心联合调查方法,在全国设置22个研究中心,各研究中心的专家组成专家组,专家组讨论通过并制定CP调查问卷,由计算机专业人员根据问卷编制CP流行病学调查数据库软件,各中心负责将本中心调查的病例资料录入调查软件,调查时间为1994年5月至2004年5月.结果 共收集CP 1 994例,我国CP发病人数从1995年的48例逐年上升到2003年的346例,发病年龄在5 ~ 85岁之间,平均年龄(48.9 ± 15.0)岁,高峰在60岁,男女性别比例为1.86∶1.我国经济发达地区发病人数较多.多元统计分析显示,长期过量饮酒、胆道疾病、胰腺外伤为主要病因,分别占35.4%、33.9%和10.5%.CP以腹痛为主要临床症状,占76.8%.诊断方法以EUS和ERCP诊断敏感性和特异性较高.治疗方法以药物和内镜治疗为主,分别占69.1%、16.8%.CP的预后以及CP同胰腺癌的关系有待进一步随访研究.结论 我国CP发病人数呈逐年上升趋势;酒精已经成为我国CP的主要致病因素;EUS和ERCP为诊断CP的主要方法;药物及内镜治疗是主要治疗措施.  相似文献   

2.
目的 评价EUS和ERCP对慢性胰腺炎(CP)的诊断灵敏度和特异度,探讨在CP诊断中EUS和ERCP的价值.方法 采用多中心联合调查方法,回顾分析1994年5月至2004年5月全国22个分研究中心的确诊的CP病例,以组织学诊断为"金标准",采用接受者工作曲线(receiver operating characteristic,ROC)分析EUS和ERCP的诊断灵敏度和特异度.结果 共人选CP患者1994例,男1298例,女696例.年龄5~85(48.9 ±15.0)岁.所有CP患者中,有组织学诊断239例(11.98%);胰腺外分泌功能试验(BT-PABA)261例(13.09%),腹部平片416例(20.86%),腹部B超1424例(71.41%),CT 889例(44.58%),MRI和MRCP245例(12.29%),ERCP628例(31.49%),EUS258例(12.94%).各诊断方法的诊断灵敏度和特异度分别为EUS(88%和93%)、ERCP(87%和93%)、MRI和MRCP(66%和85%)、CT(61%和85%)、B超(69%和82%)、腹部平片(32%和80%)、BT-PABA(83%和80%).结论 在CP诊断方法中,EUS和ERCP对CP且具有较高的灵敏度和特异度,EUS较ERCP灵敏度和特异度更高.  相似文献   

3.
目的 分析我国慢性胰腺炎(CP)常用的诊断方法 及其对CP的诊断敏感性和特异性,探索简便、易行、准确性高的CP诊断方法 .方法 采用多中心联合调查方法 ,回顾分析全国22个分研究中心的cP确诊病例.调查时间为1994年5月至2004年5月.并以同期入院无胰腺疾病患者为对照,采用受试者工作曲线(ROC)分析CP诊断方法 的敏感性和特异性.结果 共入选CP患者1994例,男性1298例(65.1%),女性696例(34.9%).男女性别比为1.86:1.年龄5-85(48.9±15.0)岁.所有CP患者中,有组织学诊断239例(11.98%);胰腺外分泌功能-N-苯甲酰-L-酪氨酰-对氨基苯甲酸试验(N-benzoyl-L-tyrosyl-paminobergoic acid,BT-PABA)261例(13.09%).X 线腹部平片416例(20.86%)、腹部B超1424例(71.41%)、计算机断层成像(CT)889例(44.58%)、磁共振成像(MRI)和磁共振胰胆管显影(MRCP)245例(12.29%)、内镜逆行胰胆管造影(ERCP)628例(31.49%)、超声内镜(EUS)258例(12.94%).各诊断方法 的诊断敏感性和特异性分别为EUS(88%和93%)、ERCP(87%和93%)、MRI和MRCP(66%和85%)、CT(61%和85%)、B超(69%和82%)、X线腹部平片(32%和80%)、BT-PABA(83 和80%).结论 我国CP诊断方法 中,腹部B超应用最为广泛,BT-PABA为常用的胰腺外分泌功能检查方法 .EUS对CP且具有较高的敏感性争特异性.  相似文献   

4.
目的评价超声内镜(EUS)对特发性胰腺炎(IP)病因诊断的价值。方法采用超声胃镜水囊法结合水充盈法,对30例临床诊断为IP的患者进行EUS检查,同时与ERCP、MRCP等影像学结果比较。结果 30例IP病因诊断阳性率依次为:EUS66.6%(18/27),ERCP75.0%(21/28),MRCP26.9%(7/26)。EUS与ERCP诊断符合率接近,差异无统计学意义(P〉0.05);EUS对胆管微小结石,胰腺导管内乳头状黏液瘤(IPMNs)的诊断阳性率最高;而ERCP对胰腺分裂症、胆总管囊肿、肝吸虫感染及乳头括约肌功能不全(SOD)诊断价值最高。结论 EUS可作为IP病因诊断的首选筛查手段,联合EUS与ERCP、MRCP对特发性胰腺炎的病因诊断具有较高的价值。  相似文献   

5.
目的探讨内镜超声检查术(EUS)在胰管扩张病因及恶性疾病邻近脏器浸润的诊断价值.方法分析129例EUS检查发现胰管扩张的病因,并与同期接受CT检查(n=40)与ERCP检查(n=42)的结果相比较.对其中72例胰腺癌引起的胰管扩张病例,分析EUS对邻近脏器浸润检出率,并与CT、ERCP结果相比较.结果 129例胰管扩张病例中,胰腺癌、壶腹癌、慢性胰腺炎为常见病因.EUS对病因检出率较CT及ERCP高.EUS对胰腺癌邻近血管侵犯及淋巴结转移检出率较CT及ERCP高.结论 EUS对胰管扩张的病因诊断较CT及ERCP有明显的优越性,并能全面评估肿瘤的可切除性,指导制定治疗方案.  相似文献   

6.
超声内镜对胰管扩张性疾病的诊断价值   总被引:1,自引:0,他引:1  
目的 探讨内镜超声检查术(EUS)在胰管扩张病因及恶性疾病邻近脏器浸润的诊断价值。方法 分析129例EUS检查发现胰管扩张的病因,并与同期接受CT检查(n=40)与ERCP检查(n=42)的结果相比较。对其中72例胰腺癌引起的胰管扩张病例,分析EUS对邻近脏器浸润检出率,并与CT、ERCP结果相比较。结果 129例胰管扩张病例中,胰腺癌、壶腹癌、慢性胰腺炎为常见病因。EUS对病因检出率较CT及ERCP高。EUS对胰腺癌邻近血管侵犯及淋巴结转移检出率较CT及ERCP高。结论 EUS对胰管扩张的病因诊断较CT及ERCP有明显的优越性,并能全面评估肿瘤的可切除性,指导制定治疗方案。  相似文献   

7.
超声内镜在慢性胰源性腹痛中的诊断价值   总被引:1,自引:1,他引:0  
目的 评价内镜超声检查术(EUS)检查在慢性胰源性腹痛中的诊断价值。方法 回顾性分析北京协和医院1991—2004年期间106例疑为慢性胰源性腹痛的患者(除外疑为肿瘤引起的胰腺实性或囊实性占位性病变者)的EUS检查结果及其相关临床资料。结果 (1)慢性胰腺炎(CP)占慢性胰源性腹痛病因的首位(57.5%),其次是其他胰腺相关疾病(18.9%),不明原因者占11.3%。(2)EUS诊断CP的敏感性和特异性分别为95.1%和64.4%,阳性预测值和阴性预测值分别为78.4%和90.6%。(3)胰腺实质系统异常(90.2%)是CP的主要EUS表现,其中回声不均伴散在点状强回声或钙化(52.5%)是最常见的表现,而单纯回声不均与局灶回声增强诊断CP的特异性相对较低(P〉0.05);胰管扩张(34.4%)则是EUS检查CP最常见的胰管系统表现。炎性假瘤型CP多表现为胰头低回声实性占位,与胰腺癌鉴别存在一定难度。(4)EUS与ERCP或BT—PABA诊断的总体符合率分别为:77.8%、70.4%,联合诊断正确率分别为100%、95.8%。结论 CP是慢性胰源性腹痛(除外疑为肿瘤引起的胰腺实性或囊实性占位性病变者)最主要的病因。EUS诊断CP的敏感性较高但特异性相对不足。EUS对胰管病变的敏感性稍逊于ERCP。  相似文献   

8.
影像学检查在诊断慢性胰腺炎中的意义   总被引:4,自引:0,他引:4  
目的 分析评价多种影像学检查在慢性胰腺炎诊断中的作用 ,有助于慢性胰腺炎的诊断。方法 回顾性总结北京协和医院 1991~ 2 0 0 0年间确诊的慢性胰腺炎患者 12 9例 ,分析体外超声 (US)、计算机X线断层摄影 (CT)、内镜逆行胰胆管造影 (ERCP)、超声内镜 (EUS)及磁共振胰胆管显影 (MR CP)在诊断慢性胰腺炎中的作用。结果 ①EUS和MRCP诊断慢性胰腺炎的敏感性高 ,与ERCP的一致性较好。②ERCP的敏感性显著高于US与CT(P <0 .0 5 )。③US对胰管扩张检出的敏感性与特异性为 5 9.4 %与 93.8% ,CT分别为 6 0 .0 %与 95 .7%。④胰管病变重度组ERCP与BT PABA的一致率(87.5 % )较轻 中度组 (6 6 .7% )高。⑤慢性胰腺炎并发症越多 ,胰管病变程度越重。结论 在传统检查中 ,ERCP诊断慢性胰腺炎的敏感性最高 ;新近开展的EUS和MRCP敏感性高 ,且与ERCP有较好的一致性 ,是很有前途的检查方法  相似文献   

9.
目的探讨胰腺结石的EUS和ERCP表现及其诊断价值.方法分析经手术或内镜下胰管取石确诊35例胰腺结石患者的EUS和ERCP检查结果.结果 35例中ERCP诊断27例(78.3%),8例诊断不明.伴有胰实质结石的4例患者ERCP均未能对胰实质结石做出诊断.而EUS诊断33例(94.3%),其中4例胰实质结石全部显示,2例胰管小结石未能诊断,EUS和ERCP联合检查全部35例均获得诊断.结论 ERCP联合EUS可提高胰腺结石诊断的准确率.  相似文献   

10.
流行病学调查表明,胰腺肿瘤的发病率逐渐上升,建立有效的早期胰腺癌的诊断方法迫不及待。由于超声内镜(EUS)和超声内镜引导下的细针吸取(EUS—FNA)细胞学检查独特的诊断能力,1994年以来,EUS—FNA应用于胰腺疾病诊断的安全性、操作性及准确性的报道相继出现,现已成为胰腺肿块的重要诊断工具,本文将就其对胰腺肿瘤诊断的应用作一综述。[第一段]  相似文献   

11.
Survey on chronic pancreatitis in the Asia-Pacific region   总被引:7,自引:0,他引:7  
BACKGROUND AND AIMS: A survey was conducted of chronic pancreatitis (CP) in different countries in the Asia-Pacific region. The main objective of the survey was to generate a database containing information regarding the prevalence, etiology, clinical presentation, diagnostic work-up, and management of CP in the Asia-Pacific region. METHODS: Data were collected from seven countries using a structured questionnaire. Expert participants were asked to respond to the questionnaire based on the data of patients with CP studied in their centers. RESULTS: The prevalence of CP was found to be very high in southern India (114-200/100 000 population), in contrast to the low reported rate of 4.2/100 000 population in Japan. Alcohol was the most common etiological factor in Australia (95%) and Japan (54%) while idiopathic pancreatitis was the most common type in India (tropical pancreatitis) and China, accounting for approximately 70% of all cases of CP. Pain was the most common clinical feature. Diabetes and steatorrhea were uncommon. With regard to the diagnosis of CP, all the experts believed that a patient could be diagnosed as having CP in the presence of any one or more of the following: ductal changes on endoscopic retrograde cholangiopancreatography, a positive secretin test, pancreatic calcification, and endosonographic abnormalities suggestive of CP. Most experts suggested pancreatic enzymes and analgesics as initial medical therapy for pain relief in CP. Endotherapy was suggested as the therapy of choice if medical therapy failed. Surgery was offered only after the failure of endotherapy. Most experts agreed that research should focus on genetic abnormalities in CP and the role of endotherapy for pain relief. CONCLUSION: The survey brought out the prevalent types and presentation of CP, common management practices, and also the shortcomings in the existing knowledge of CP in the Asia-Pacific region. These findings might help focus attention on the research priorities for CP in this region.  相似文献   

12.
慢性胰腺炎(chronic pancreatitis,CP)无规律地分布于世界各地,不同的国家和地区,CP的致病因素与发病率均有较大的差异.在西方国家,酒精是其主要致病因素,而在我国为胆道疾病.随着人民生活方式的改变,CP的致病因素在不断变更.近年来我国酒精因素所占比例上升,逐渐替代胆道疾病成为CP的第一致病因素.随着检测技术的提高,CP的病因正被不断的发现和完善,从而进一步指导CP的治疗.  相似文献   

13.
Background and Aims: There is a paucity of literature regarding the clinical profile of chronic pancreatitis (CP) in children. The aims of this retrospective study were to determine the etiology and clinical presentation, and to present our experience in diagnosing CP in children in China. Methods: Clinical data of children who were treated for CP at Changhai Hospital from January 1997 to August 2006 were reviewed. Results: A total of 427 CP patients presented to our center. There were 42 (9.8%) children with CP, including 21 males and 21 females, with a mean age of 11.7 years at the first onset. The main etiological factor was idiopathic (73.8%). Of the patients, 78.5% had episodes of mild to moderate abdominal pain and 54.8% had multiple (≥ 4) episodes. The mean duration of symptoms prior to the diagnosis was 41.6 months and a definite diagnosis was not made until 2 years later in 57.1% of these patients. The positive rates of ultrasound (US), computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) (or magnetic resonance imaging [MRI]) for detecting ductal changes and intraductal stones or pancreatic calcification were 51.4% and 45.4%, 71.4% and 87.5%, 80.0% and 61.5%, respectively. Conclusion: The main etiological factor of Chinese children with CP is idiopathic. The main symptom in these patients is multiple episodes of mild to moderate abdominal pain, which often lead to a delay in the definite diagnosis. CT and MRCP (or MRI) should be used as the first investigation in the evaluation of these cases.  相似文献   

14.
BACKGROUND: Recent advances in molecular and genomic technologies and pancreatic imaging techniques provided some insights into genetic, environmental, immunologic, and pathobiological factors for chronic pancreatitis (CP). This study was undertaken to investigate the clinical manifestations of patients with chronic pancreatitis at our hospital. METHODS: The data of the patients with CP who had been treated at our hospital between 1997 and 2004 were analyzed. RESULTS: The major symptoms of the patients with CP were abdominal pain, dyspepsia, loss of weight, diabetes mellitus, pancreatic pseudocyst, steatorrhea, and calcification. Biliary diseases were found to be the first cause of CP in this study; but alcohol abuse was the major cause of CP in men and biliary diseases were the first etiological factors for CP in women. The etiological difference of constituent ratio between men and women was related to alcohol comsumption (P<0.01). CONCLUSIONS: During the past 8 years, biliary diseases have been the major etiological factors for CP, but their constituent ratio is decreasing, and the constituent ratio of alcohol abuse is increasing gradually. Alcohol tends to replace biliary diseases as the primary etiological factor for CP.  相似文献   

15.
ObjectivesA nationwide survey was conducted to clarify the epidemiological features of patients with chronic pancreatitis (CP) in Japan.MethodsTwo sequential surveys were conducted. In the first survey, both the prevalence and incidence of CP in Japan in 2007 were estimated by a questionnaire, which was mailed to 3027 randomly chosen Japanese facilities. In the second survey, the second questionnaire was then mailed to 1110 facilities selected by the first survey to clarify the clinicoepidemiological features of the patients.ResultsThe estimated annual prevalence of CP was 36.9 per 100,000; 53.2 in males and 21.2 in females. The estimated annual incidence was 11.9 per 100,000. The prevalence and the incidence of CP gradually increased in Japan as compared to former surveys. The sex ratio (male/female) of definitive and probable CP patients was 4.5, with a mean age of 59.4 years; 59.2 years in males and 60.2 years in females. Alcoholic (69.7%) was most the common and idiopathic (21.0%) was the second most common cause of CP. The proportion of alcoholic CP increased as compared to the 55.5% found in 1994. The clinical features of overall Japanese patients with CP were: abdominal pain (60.6%), malabsorbtion (12.2%), diabetes mellitus (39.7%) and pancreatolithiasis (75.7%). Alcoholic patients were characterized by high morbidity as compared to nonalcoholic patients: abdominal pain (alcoholic 65.0% vs nonalcoholic 53.0%, p < 0.0001), diabetes mellitus (44.8% vs 31.4%, p < 0.0001) and pancreatolithiasis (84.0% vs 60.8%, p < 0.0001).ConclusionThe prevalence and the incidence of CP, especially alcoholic CP, have been increasing in Japan.  相似文献   

16.
目的 分析慢性胰腺炎(CP)糖尿病发生率及可能风险因素.方法 分析和随访1997年1月-2007年7月疼痛性CP患者资料,寿命表法计算首次腹痛后累积糖尿病发生率,Cox比例风险模型逐步回归分析风险因素,包括年龄、性别、吸烟、饮酒、病因、胰腺肿块、胰腺钙化、治疗方案、伴腹泻、体重减轻和腹痛程度.结果 人组病例共354例,男:女=2.1:1,首发年龄(38.1±17.6)岁,随访时间(45.2±32.9)个月;酒精性CP 18.1%;总糖尿病发生率16.1%,其中需胰岛素治疗者40.3%.内镜介入和外科手术治疗前34例已确诊,治疗后新发23例;29.8%糖尿病发生于腹痛1年内;首次腹痛后1、3、5、10年内的累积糖尿病发生率分别为4.9%、6.5%、9.3%、20.7%;Cox风险比例模型回归分析显示,治疗前糖尿病组中吸烟量>200年支(年支定义每天吸烟支数×吸烟年数)、轻度腹痛、体重减轻、胰腺钙化为风险因素,风险比分别为3.3、5.2、2.6、2.2;新发糖尿病组中,吸烟量>200年支、持续或新发体重减轻、胰尾/体尾部切除术等因素为风险因素,风险比分别为3.0、2.8、7.3.结论 对吸烟量>200年支、胰腺钙化、轻度腹痛、体重减轻以及接受胰尾/体尾部切除治疗的CP患者尤应注意伴发糖尿病的可能.  相似文献   

17.
《Pancreatology》2014,14(4):275-279
Background/objectivesThe present study was undertaken to determine the prevalence of malnutrition among children with chronic pancreatitis (CP). Furthermore, we aimed to evaluate the relationship between etiological factors of CP, its clinical characteristics, and the severity of malnutrition.MethodsThe study included 208 children with CP (113 girls and 95 boys; mean age: 10.8 years, range: 1.6–18 years), hospitalized at our center between 1988 and 2012. The severity of malnutrition was graded on the basis of Cole's ratios, and its prevalence was analyzed according to the etiological factors of pancreatitis. Moreover, the analysis of discrimination was performed to identify the factors contributing to malnutrition among the following variables: age at CP onset, duration of CP, number of CP exacerbations, the number of ERCPs performed, the grade of pancreatic damage documented on imaging, co-occurrence of diabetes, and the results of 72-h fecal fat quantification.ResultsWe documented features of malnutrition in 52 (25%) children with CP, including 36 (17.3%) patients with moderate malnutrition, and 2 (0.96%) with severe malnutrition. There was no significant difference in the prevalence of malnutrition between groups of patients with various etiological factors of chronic pancreatitis. The age at CP onset showed the best discrimination ability of malnourished patients: the mean age at disease onset in a subgroup of malnourished children was significantly higher than in children with Cole's index >85%.ConclusionsA considerable percentage of children with CP can suffer from clinically significant malnutrition. Later age at CP onset predisposes to development of malnutrition.  相似文献   

18.
《Pancreatology》2014,14(6):490-496
ObjectivesA nationwide survey was conducted to clarify the epidemiological features of patients with chronic pancreatitis (CP) in Japan.MethodsIn the first survey, both the prevalence and the incidence of CP in 2011 were estimated. In the second survey, the clinicoepidemiological features of the patients were clarified by mailed questionnaires. Patients were diagnosed by the Japanese diagnostic criteria for chronic pancreatitis 2009.ResultsThe estimated annual prevalence and incidence of CP in 2011 were 52.4/100,000 and 14.0/100,000, respectively. The sex ratio (male/female) of patients was 4.6, with a mean age of 62.3 years. Alcoholic (67.5%) was the most common and idiopathic (20.0%) was the second most common cause of CP. Comorbidity with diabetes mellitus (DM) and pancreatic calcifications (PC) occurred more frequent in ever smokers independently of their drinking status. Among patients without drinking habit, the incidences of DM and PC were significantly higher in ever smokers than in never smokers. The multiple logistic regression analysis revealed smoking was an independent factor of DM and PC in CP patients: DM, Odds ratio (OR) 1.644, 95% confidence interval (CI) 1.202 to 2.247 (P = 0.002): PC, OR 2.010, 95% CI 1.458 to 2.773 (P < 0.001). On the other hand, smoking was not identified as an independent factor for the appearance of abdominal pain by this analysis.ConclusionThe prevalence of Japanese patients with CP has been increasing. Smoking was identified as an independent factor related to DM and PC in Japanese CP patients.  相似文献   

19.
In Japan, the number of patients with both chronic pancreatitis (CP) and pancreatic cancer (PC) is increasing. A nationwide survey on CP revealed that the total number of patients treated for CP in Japan in 2002 was estimated as 45,200 (95% confidence interval, 35,600-54,700), and 20,137 patients died of PC in 2002. Alcoholic pancreatitis was the most common type of pancreatitis (67.5 %). Cigarette smoking was an independent and significant risk factor for CP. The risks of pancreatic and nonpancreatic cancers increased in the course of CP. While alcohol consumption may increase the risk of PC via CP, smoking was important as a risk factor for both CP and PC. The increasing incidence of PC was closely related to the increasing intake of animal fat. Lifestyle in patients with CP appeared to be the same as that in patients with PC. Environmental factors such as lifestyle in combination with genetic factors may increase the risk for both CP and PC. Therefore, changing and improving lifestyle habits such as drinking, smoking and nutrition may reduce the risks for both CP and PC.  相似文献   

20.
Background and Aims: It is not completely understood whether smoking contributes to chronic pancreatitis (CP). Past studies have included mostly patients with alcohol-related and severe CP. Our aim was to assess the relationship of smoking and CP adjusting for alcohol and other clinical riskfactors. Methods: Across-sectional study was performed of patients referred to the pancreatic disease clinic in the past 2 years with abdominal pain and suspected CP. Patients were questioned on their smoking and alcohol habits. Patients underwentan etiological workupand diagnostic evaluation for early and late CP comprised of computed tomography scan and combined endoscopic ultrasound and secretin endoscopic pancreaticfunction test if indicated. Logistic regression was used to determine the association of current smoking with CP adjusting for other riskfactors. Results: The adjusted odds ratio (OR) for current smoking was 1.99 (95% CI 1.01, 3.91). Other significant predictors included Presented atthe Annual Scientific Meeting and Postgraduate Course of the American College of Gastroenterology, Orlando, Fla., 2008. Tyler Stevens, MD, has received a research grant for an investigator-initiated study from Solvay Pharmaceuticals. consumption of ≥10 alcohol drinks/week, advancing age, history of acute pancreatitis, and the presence of another etiological factor. Smoking was also independently associated with exocrine insufficiency (OR 2.00, 95% CI 1.07, 3.75) and calcifications (OR 2.68, 95% CI 1.03, 6.94). Conclusion: Active cigarette smoking is associated with CP adjusting for alcohol and other riskfactors.  相似文献   

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