急性胰腺炎994例病因与治疗分析

目的 探讨急性胰腺炎(AP)的病因及其治疗方法 的选择.方法 回顾性分析2003年1月至2007年1月瑞金医院胰腺普外科收治的994例AP患者资料,根据病因及治疗方式进行分类统计.结果 994例AP患者中,胆源性AP 825例(83.0%),酒精性AP 24例(2.41%),高脂血症性AP29例(2.92%),妊娠性AP16例(1.61%),特发性AP 71例(7.14%),外伤性4例(0.40%),两种病因以上的混合性AP 25例(2.52%).轻症急性胰腺炎(MAP)767例(77.2%),重症急性胰腺炎(SAP)227例(22.8%).总的治愈好转率91.2%,病亡87例,病死率8.8%,其中酒精性AP的病死率达37.5%,显著高于胆源性AP.对胆源性AP患者分别采用非手术治疗、内镜逆行胰胆管造影+乳头括约肌切开(ERCP+EST)、胆囊切除术+胆总管探查或ERCP术后腹腔镜下胆囊切除术及清创引流术.采用清创引流术的患者均为SAP患者,术后病死率高达25.0%,显著高于其他治疗方法 者(P＜0.01).其他3种治疗方法 间的SAP病例比及病死率均无显著差异.结论胆道因素仍是AP的首要病因.酒精性AP病情较危重,预后较差.对胆源性AP,多种治疗方法 的疗效无显著差异.     

The etiology and clinical characteristics of 34 cases of acute recurrent pancreatitis

目的 探讨复发性急性胰腺炎患者的病因及临床特点.方法 收集我院收治的急性胰腺炎患者152例的临床资料,分析复发性急性胰腺炎患者的临床特征.结果 152例急性胰腺炎患者中,复发性急性胰腺炎组34例(22.4％),对照组即无复发组118例(77.6％).复发性急性胰腺炎患者的病因以胆源性为主(52.9％);酒精性(14.7％)、高脂血症(8.8％)和其他因素(2.9％)所占比例均低于对照组;饮食不当(8.8％)和特发性(11.9％)所占比例均高于对照组,但两组比较差异均无统计学意义(P＞0.05).复发性急性胰腺炎组患者胸水、腹水和假性囊肿形成的发生率分别为30.8％、23.1％和19.2％,对照组分别为29.2％、11.5％和3.1％,假性囊肿形成的发生率比较差异有统计学意义(P＜0.05).结论 复发性急性胰腺炎是一种常见疾病,胆道结石和酒精是其常见病因,原因不明者占较高的比例.明确病因后积极治疗原发病因,可有效减少其复发.     

各型胰腺假性囊肿的治疗策略及预后判断

目的 分析各种急性和慢性胰腺假性囊肿(PPs)的特征和预后,探讨侵入性治疗PPs的预测因子.方法 回顾性分析1995年1月至2004年12月日本医科大学诊治的36例PPs患者的临床资料.将患者分成急性胰腺炎并发的PPs自发缓解组(急性缓解组);急性胰腺炎并发的PPs症状持续或有并发症需要侵入治疗组(急性治疗组);慢性胰腺炎并发的PPs自发缓解组(慢性缓解组)和慢性胰腺炎并发的PPs症状持续或有并发症需要侵入治疗组(慢性治疗组),每组9例.结果 36例患者中,女性13例,男性23例.胰腺炎病因:酒精性18例(50.0%),胆源性8例(22.2%),其他原因10例(27.8%).平均随访时间(24.2±18.5)个月.绝大多数囊肿(32/36,88.9%)与主胰管不相交通;各组囊肿数量、部位均无显著差异;慢性缓解组囊肿直径最小,均<4 cm,显著小于其他3组(P<0.05);两缓解组的囊肿多数无增大,而两治疗组的囊肿绝大多数有增大;急性治疗组中4例(44.4%)囊壁增厚(>2～3cm),慢性治疗组中1例(11.1%)囊壁增厚,余囊壁正常.急性PPs的病因多为胆源性,多数位于胰尾,而且这些患者的体表指数、囊肿大小、确诊时有PPs相关症状的例数均显著高于慢性PPs.结论 随访期间PPs体积增大强烈提示需要侵入治疗.慢性PPs囊肿直径<4 cm是预后良好的指标,急性PPs直径<8 cm是自然消退的指标.     

胰腺囊性疾病临床诊断分析

目的 探讨胰腺囊性病变(PCL)的发病及诊断方法.方法 对经手术或病理证实为胰腺囊性病变的134例患者,从性别、年龄、病程、既往史、伴发症、症状、体征、影像学诊断等方面进行比较分析.结果 本研究共收集胰腺假性囊肿(PPC)107例、真性囊肿(TPC)12例、囊性肿瘤(PCT)15例.囊性肿瘤组女性发病率明显高于假性囊肿组(P=0.003).假性囊肿组有急、慢性胰腺炎史的病例数显著多于真性囊肿和囊性肿瘤组(P值分别为0.000和0.000),假性囊肿组胆道结石的病例数明显多于囊性肿瘤组(P=0.005),而真性囊肿组同时伴有肝、肾囊肿的病例数显著高于假性囊肿组(P=0.000).CT对假性囊肿和囊性恶性肿瘤的诊断准确率高于B超(P值分别为0.000和0.02).结论 胰腺囊性疾病应根据其发病情况、相关病史及影像学特点进行仔细分析,才能有助于明确囊性病变的性质.     

急性胰腺炎复发诱因及内镜治疗

目的 探讨急性胰腺炎(AP)复发的诱因及其内镜治疗效果.方法 杏阅2002年1月至2008年12月长海医院收治的AP患者.详细记录患者临床资料;是否行内镜逆行胰胆管造影术(ERCP)治疗、治疗方法及并发症.电话随访后根据是否AP复发将患者分为无复发组与复发组.分析两组致病因素及内镜治疗疗效.结果 804患者入组,其中无复发组512例(63.68%),复发组292例(36.32%).无复发组平均年龄52岁,复发组平均年龄44岁,相差显著(P<0.01).201例重症胰腺炎中,无复发组104例(20.31%),复发组97例(33.22%),复发组显著高于无复发组(P<0.01).无复发组并发胰腺假性囊肿46例,复发组44例,两组胰腺假性囊肿发生率差异显著(P<0.05).AP病因为胆源性、高三酰甘油血症是胰腺炎反复发作的危险因素.139例复发性AP患者行ERCP治疗,15例(5.15%)并发ERCP术后胰腺炎,1例(0.34%)出现十二指肠乳头切开后出血.成功随访内镜介入治疗的118例复发性AP患者,内镜治疗总缓解率为78.8%.结论 复发组发病年龄较小,重症急性胰腺炎发生率及胰腺假性囊肿发生率均高,胆源性及高三酰甘油血症为诱发AP复发的危险因素.内镜介入治疗对复发性AP同样有效.     

135例慢性胰腺炎临床病例分析

探讨慢性胰腺炎的不同病因和临床表现特点。回顾性分析本院135例慢性胰腺炎的住院患者的主要病因包括胆道系统疾病(31．85％)和酒精中毒(35．56％),其他病因包括特发性、自身免疫性疾病、外伤或遗传等。酒精性CP临床症状发生的比例较胆源性高,特别是腹痛、腹泻、糖尿病的发生率明显高于胆源性CP。酒精性与非酒精性CP组、对照组相比,TG、HDL-C、G／HDL-C差别显著。胆道系统疾病和酒精中毒为CP主要病因,近年来酒精性因素呈上升趋势。临床表现上,酒精性较胆源性CP的发生率高。TG／HDL-C比值可能有助于鉴别酒精性和非酒精性胰腺炎。     

胰腺假性囊肿19例临床分析

胰腺假性囊肿(pancreatic pseudocyst, PPC)是一种继发于急、慢性胰腺炎、外伤或胰腺术后的并发症.本文通过对19例PPC患者的临床表现、实验室及影像学检查、治疗方法的分析,以期能对PPC的早期发现、治疗提供一定帮助,现结合文献报告如下.     

非手术治疗急性重症胆源性胰腺炎

目的探讨急性重症胆源性胰腺炎非手术治疗的效果和中转手术的指征.方法回顾分析本院收治157例急性重症胆源性胰腺炎非手术治疗的死亡率、并发症和中转手术的情况.结果 157例中治愈145例,死亡12例,治愈率92.4%.治疗过程中有65例出现各类并发症,其中多器官功能不全或衰竭18例(11.5%),坏死组织继发感染6例(3.8%),胰腺假性囊肿29例(18.5%),急性肺损伤25例.患者预后与入院时APACHE-Ⅱ评分有关.有9例中转手术(5.7%),包括6例胰腺坏死组织继发感染和2例不能控制的胆道感染.梗阻性和非梗阻性重症胆源性胰腺炎在死亡率和胰腺坏死组织继发感染发生率上相似.结论急性重症胆源性胰腺炎经积极非手术治疗可获得满意疗效.梗阻性急性重症胆源性胰腺炎当存在不能控制的胆道感染时需早期行胆道手术.中转手术的指征为胰腺坏死组织继发感染、不能控制的胆道感染及治疗期间出现其他外科并发症.     

慢性胰腺炎294例的病因学及临床诊治

目的:研究我国慢性胰腺炎的相关因素及诊治特点方法:回顾分析长海医院近10 a确诊为慢性胰腺炎的294例住院患者,调查其相关病因、诊断方法及治疗措施. 结果:在294例患者中,胆源性89例(30.3%),酒精性84 例(28.6%),其他病因包括腹部手术后、胰腺外伤、胰管先天异常、自身免疫病、先天因素以及特发性等,均较少见.大部分患者表现为反复发作性腹痛,少数伴有脂肪泻及体重减轻等症状.49例患者通过组织学检查确诊,其他均通过影像学检查及BT-PABA试验诊断.大部分患者(81.0%)经非手术治疗症状缓解. 结论:慢性胆道系统疾病仍是我国慢性胰腺炎的主要致病因素,但其比例明显下降,而酒精性慢性胰腺炎明显增多.影像学检查在慢性胰腺炎诊断中具有重要作用,非手术治疗是目前治疗慢性胰腺炎的主要方法.     

胰腺假性囊肿的病因、转归与治疗

胰腺囊肿可分为胰腺真性囊肿和胰腺假性囊肿 (pancr- eatic pseudocyst, PPC)二种类型.真性者有先天性囊肿或肿瘤性囊肿,在囊肿内具有上皮组织,仅占胰腺囊肿总数的15%.假性者为胰腺内或胰腺周围液体的积聚,以后由纤维素性包膜所包裹,不具有上皮组织,占胰腺囊肿总数的85%,本文就有关PPC方面的文献作一综述.     

Etiology of acute pancreatitis--a multi-center study in Taiwan

BACKGROUND/AIMS: Little is known about the etiology of acute pancreatitis in Taiwan. The aim of this study was to evaluate the current etiology of acute pancreatitis in Taiwan by a multi-center cooperative study. METHODOLOGY: Patients with acute pancreatitis were collected from 8 major leading hospitals located at northern, southern, middle and eastern Taiwan from July 1, 1998 to June 30, 2000. The diagnosis of acute pancreatitis was based on characteristic clinical signs and symptoms and three-fold elevation of serum amylase/lipase level or positive evidence in imaging studies. The etiology was attributed to alcohol, gallstones, hypertriglyceridemia, miscellaneous causes, and idiopathic causes. RESULTS: In total 1,193 patients with acute pancreatitis were identified. There were 852 (71.4%) men and 341 (28.6%) women with a mean age of 52.5 years, ranging from 9 to 100 years. Etiology was identified as alcohol in 423 (33.6%), gallstones in 407 (34.1%), hypertriglyceridemia in 147 (12.3%), miscellaneous causes in 109 (9.1%), and idiopathic causes in 107 (9.0%). Patients with alcohol-related acute pancreatitis were the youngest (mean age: 41.5 years), while those with gallstone pancreatitis were the eldest (mean age: 64.1 years) (p < 0.001). The predominant cause of acute pancreatitis in women is gallstones, while alcohol is the leading cause of acute pancreatitis in Taiwanese males. In northern Taiwan, gallstone is the major cause of acute pancreatitis, while alcohol is the predominant etiology in middle, southern, and eastern Taiwan. CONCLUSIONS: Alcohol has become the predominant cause of acute pancreatitis in Taiwan recently. Ecological and gender differences play important roles in the etiology of acute pancreatitis in Taiwan.     

Minimally invasive treatment of pancreatic pseudocysts

A pancreatic pseudocyst(PPC) is typically a complication of acute and chronic pancreatitis, trauma or pancreatic duct obstruction. The diagnosis of PPC can be made if an acute fluid collection persists for 4 to 6 wk and is enveloped by a distinct wall.Most PPCs regress spontaneously and require no treatment, whereas some may persist and progress until complications occur. The decision whether to treat a patient who has a PPC, as well as when and with what treatment modalities, is a difficult one. PPCs can be treated with a variety of methods: percutaneous catheter drainage(PCD), endoscopic transpapillary or transmural drainage, laparoscopic surgery, or open pseudocystoenterostomy. The recent trend in the management of symptomatic PPC has moved toward less invasive approaches such as endoscopic- and image-guided PCD. The endoscopic approach is suitable because most PPCs lie adjacent to the stomach. The major advantage of the endoscopic approach is that it creates a permanent pseudocysto-gastric track with no spillage of pancreatic enzymes. However, given the drainage problems, the monitoring, catheter manipulation and the analysis of cystic content are very difficult or impossible to perform endoscopically, unlike in the PCD approach. Several conditions must be met to achieve the complete obliteration of the cyst cavity.Pancreatic duct anatomy is an important factor in the prognosis of the treatment outcome, and the recovery of disrupted pancreatic ducts is the main prognostic factor for successful treatment of PPC, regardless of the treatment method used. In this article, we review and evaluate the minimally invasive approaches in the management of PPCs.     

A prospective study of the aetiology, severity and outcome of acute pancreatitis in Eastern India.

BACKGROUND: Acute pancreatitis is a common cause of hospital admission. The aim of this study was to evaluate the aetiology, severity and outcome of acute pancreatitis in our tertiary referral center. METHODS: Between August 2002 and December 2003, 45 cases of acute pancreatitis were admitted to the hospital. Diagnosis was ascertained by clinical examination and investigations (hyperamylasaemia). The severity was assessed by the Acute Physiology and Chronic Health Evaluation scoring system and contrast enhanced computed tomography scan. The patients were treated according to a designed protocol. The data related to aetiology, severity and outcome were noted for subsequent analysis. RESULTS: Of the 45 patients, 33 were male and 12 were female. The mean age was 30 years. Of the 45 patients, 34 patients had mild pancreatitis and 11 had severe pancreatitis. The aetiology spectrum of mild pancreatitis included the following: alcoholism in 14 (41.1%), gallstones in 8 (23.5%), trauma in 6 (17.6%), idiopathic in 4 (11.7%) and post-endoscopic retrograde cholangiopancreatography in 2 (5.8%). The causes of severe acute pancreatitis came under the following headers: trauma in 3 (27.2%), idiopathic in 2 (18.1%), gallstones in 2 (18.1%), alcoholism in 2 (18.1%) and post-endoscopic retrograde cholangiopancreatography in 2(18.1%). Mild pancreatitis led on to the following: pancreatic abscess in 1, pseudocyst in 3 and readmission for pain relapse within 6 months in 10 patients. The remainder had uneventful recoveries. There was no mortality in this group. Severe acute pancreatitis led on to the following: symptomatic sterile pancreatic necrosis in 2, infected pancreatic necrosis in 2, pancreatic abscess in 2 and presentation 8 months later with colonic stricture in 1 patient. There were 2 deaths in this group due to multi-organ failure. CONCLUSION: Although gallstones have largely been implicated as a common cause of acute pancreatitis our study found alcoholism as the main aetiological factor. Blunt abdominal trauma was also seen as a common cause of acute severe pancreatitis, particularly severe acute pancreatitits, as seen in our series. The outcome in mild pancreatitis was good, severe acute pancreatitis leads to more complications and greater mortality, thus requiring careful medical and surgical management.     

Preoperative physical activity levels and postoperative pulmonary complications post‐esophagectomy

Postoperative pulmonary complications (PPCs) after esophagectomy have been reported to occur in 15–30% of patients and are the most common causes of major morbidity and mortality. Risk factors for the development of PPCs include impairment in lung function, cardiac reserve, aerobic capacity, and body composition. Physical activity is associated with these factors but has not been examined in relation to the risk of developing a PPC. The aim of this cross‐sectional study was to investigate if there was a difference in physical activity levels, lung function, and body composition in patients who developed a PPC post‐esphagectomy compared with those who did not. Consecutive patients were studied preoperatively: (i) lung function with a portable micro‐medical spirometer; (ii) body composition analysis using a Tanita BC 418 machine (Tanita Corp., Tokyo, Japan); and (iii) physical activity with an accelerometer (RT3, (StayHealthy, Monrovia, CA, USA)). Thirty‐seven patients were studied, mean age 61 ± 9 years. PPCs developed in 10 patients (27%). Smoking status, lung function, and body composition were similar in both groups. For physical activity, there were significant differences in the time spent sedentary (20.0 ± 1.5 h/day [PPC], 18.4 ± 2.1 h/day [non‐PPC]; P < 0.05) and in moderate activity (20 ± 13.7 min/day [PPC], 36 ± 20.7 min/day [non PPC]; P < 0.01). Patients who developed a PPC engaged in less physical activity than those who did not; hence, targeting physical activity preoperatively may result in less PPCs.     

Endoscopic ultrasound-guided drainage of peripancreatic fluid collections: What impacts treatment duration?

Background: Peripancreatic fluid collections(PFCs) are complications resulting from acute or chronic pancreatitis and require treatment in certain clinical conditions. The present study aimed to identify the factors influencing the duration of endoscopic ultrasound(EUS)-guided drainage of symptomatic pancreatic pseudocysts(PPCs), walled-off necrosis(WON), and acute necrotic collections(ANCs). Methods: This was a retrospective cohort study of 68 patients with PFCs who underwent EUS-guided drainag...     

215例慢性胰腺炎病因学分析

目的：探讨我国慢性胰腺炎的病因。方法：回顾性分析1990－2000年北京协和医院215例慢性胰腺炎患者的病因。结果：215例慢性胰腺炎患者的病因中,胆道系统疾病占36．7％,酒精中毒占26．5％,特发性占30．2％,其他病因包括自身免疫性疾病、急性胰腺炎、外伤和遗传等。胆道系统疾病中以胆囊结石最为多见,其次为胆管结石和胆囊炎。结论：我国慢性胰腺炎的病因以胆道系统疾病为主,而酒精性因素呈上升趋势,自身免疫性疾病作为慢性胰腺炎的病因正逐渐受到重视。     

Chronic pancreatitis in Eastern India: Experience from a tertiary care center

There is a wide variation in the clinical presentation of chronic pancreatitis (CP) in the different parts of India. Data regarding the clinical profile of CP from eastern India are scarce. We describe the clinical and demographic profiles of patients with CP in eastern India. Consecutive patients were evaluated for the clinical presentation, etiology and complication of CP. One hundred and thirty-nine patients with CP (mean age 39.57±14.88 years; M/F 3.48:1) were included. Idiopathic CP (50.35%) was the most common etiology followed by alcohol (33.81%); 68.34% had calcific CP and 31.65% had noncalcific CP. The median duration of symptoms was 24 (1–240) months. Pain was the most common symptom, being present in 93.52% of the patients. Diabetes, steatorrhea and pseudocyst were present in 45.32%, 14.38% and 7.19% of the cases, respectively. Moderate to severe anemia was revealed in 16.53% of the patients. Benign biliary stricture was diagnosed in 19.42% of the cases (symptomatic in 6.47%). The common radiological findings were the following: pancreatic calculi (68.34%), dilated pancreatic duct (PD) (58.99%), parenchymal atrophy (25.89%) and PD stricture (23.74%). In our center, idiopathic CP followed by alcoholic CP was the most frequent form of CP. Tropical CP was distinctly uncommon.     

Acute pancreatitis caused by <Emphasis Type="Italic">Mycoplasma pneumoniae</Emphasis>: an unusual etiology

It is well known that the most important etiologies of acute pancreatitis are gallstones and alcohol consumption. Once these causes have been ruled out, especially in young adults, it is important to consider less frequent etiologic factors such as drugs, trauma, malformations, autoimmunity or systemic diseases. Other rare and less well studied causes of this pathology are infections, among which Mycoplasma pneumoniae has been reported to cause acute pancreatitis as an unusual extrapulmonary manifestation. Here, we report the case of a 21-year-old patient who had acute idiopathic pancreatitis associated with an upper respiratory tract infection. After an in-depth study, all other causes of pancreatitis were ruled out and Mycoplasma was established as the clinical etiology.     

Etiological analysis of chronic pancreatitis in 215 cases

OBJECTIVE: To investigate the etiology of chronic pancreatitis in China. METHODS: The causes of 215 cases of chronic pancreatitis treated at Peking Union Medical College Hospital between 1990 and 2000 were analyzed retrospectively. RESULTS: The causes of chronic pancreatitis were biliary diseases (36.7%), alcoholic (26.5%), idiopathic (30.2%), and other uncommon causes such as auto­immune disease, recurrent acute pancreatitis, trauma and heredity. Among biliary diseases, the most common cause was cholecystolithiasis, followed by bile duct stone and cholecystitis. CONCLUSIONS: The main cause of chronic pancreatitis in China is biliary disease. That caused by ethanol is increasing, and autoimmune disease is also receiving increasing attention.     

Epidemiology of pancreatic diseases in Lüneburg county: A study in a defined German population

Background/Aims: Worldwide, the incidence of pancreatic cancer is very well known, that of acute pancreatitis and chronic pancreatitis not. Our study sought to determine the incidence of all three pancreatic diseases in a well-defined population in Germany. Methods: Records of all patients treated for acute (first attacks only) and chronic pancreatitis as well as pancreatic cancer from 1988 to 1995 and who resided in the county of Lüneburg were evaluated. Results: The crude incidence rates for acute pancreatitis, chronic pancreatitis and pancreatic cancer per 100,000 inhabitants/year were 19.7, 6.4, and 7.8. In acute and chronic pancreatitis the male gender dominated, whereas in pancreatic carcinoma the gender ratio was almost even. Peak incidence for acute pancreatitis was in the age group of 35–44 years, for chronic pancreatitis 45–54, and for pancreatic cancer 6575. Etiology of acute pancreatitis was biliary in 40%, alcohol abuse in 32%, unknown in 20%, and other in 8% of the patients. In chronic pancreatitis alcohol abuse was the etiology in 72% and unknown (idiopathic) in 28%. Conclusion: For the first time, epidemiological data obtained in a well-defined German population are being published relating to all three pancreatic diseases: acute pancreatitis (incidence rate, etiology and severity), chronic pancreatitis (incidence rate and etiology), and pancreatic carcinoma (incidence rate). A peak incidence of chronic pancreatitis occurring in an age group 10 years older than the peak age group for acute pancreatitis suggests that chronic pancreatitis develops during this time-frame following first attacks of acute pancreatitis.