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.     

胆囊切除前急性胆源性胰腺炎和胆囊切除后急性胰腺炎临床分析

[目的]总结胆囊切除前急性胆源性胰腺炎与胆囊切除后急性胰腺炎的临床特点,增加对胆源性急性胰腺炎病因的了解。[方法]回顾性比较分析15例胆囊切除前急性胆源性胰腺炎(组1)和15例胆囊切除后急性胰腺炎(组2)的临床资料。[结果]组1的病因均为胆囊结石,且12例经病理证实为胆囊多发小结石,胆囊切除后急性胰腺炎占同期急性胰腺炎比例为9.2%;15例中5例为胆源性,10例病因未明。组2的15例中有5例为复发性。2组高于正常的指标的病例数比较:组1中DB/TB(50%)、GGT异常例数均多于组2(P0.05)。血液生化检验指标2组间差异无统计学意义。[结论]胆囊切除前急性胆源性胰腺炎的主要病因是胆囊多发小结石;多数病例DB/TB(50%)、GGT高于正常。胆总管复发结石为胆囊切除术后急性胰腺炎的重要病因,后者具有复发性,应多开展相关研究。     

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.     

急性复发性胰腺炎23例分析

急性胰腺炎是常见、多发的疾病,其中复发性胰腺炎占急性胰腺炎的10%～20%[1],由于胰腺炎症的反复发作,损伤可以引起胰腺组织的修复以及纤维化的形成,而导致慢性胰腺炎,使患者的生活质量严重下降,所以在治疗急性胰腺炎的同时,积极寻找其病因,并尽可能去除病因,减少急性胰腺炎的复发也是临床治疗的关键,现将我院2000年2月至2008年2月间23例复发性胰腺炎的诊治情况总结如下.     

老年急性胰腺炎53例临床分析

目的探讨老年急性胰腺炎的临床特征及诊治方法。方法回顾性分析53例老年急性胰腺炎患者的临床资料。结果老年急性胰腺炎多合并有基础疾病,诱发因素主要为胆系疾病39例,占73.6%,临床主要表现为腹痛、腹胀、发热等。行急诊手术9例,术后6例发生并发症,经对症处理后均好转,死亡3例;行择期手术21例,术后发生并发症10例,经对症处理后均好转;其余23例经非手术保守治疗痊愈。结论老年急性胰腺炎主要病因为胆系疾病,临床表现多种多样,症状不典型,且合并症多,病情重,内科积极治疗有助于改善预后。     

EST在复发性胰腺炎诊疗中的运用

近 10余年来 ,随着内镜技术的不断发展 ,其在胰腺疾病的诊治中的应用日趋成熟 ,具有安全、简便、并发症少等优点 ,已成为治疗胰腺疾病的重要手段 ,使胰腺疾病的微创治疗进入了一个新阶段。急性胆源性胰腺炎采取内镜治疗已作为首选 ,对于复发性胰腺炎特别是特发性胰腺炎采用内镜诊断 ,不仅可以明确其病因 ,并可根据病因采取相应的内镜治疗 ,取得了良好的疗效 ,使复发性胰腺炎获得完全治愈有了新的突破。1　复发性胰腺炎发病的主要病因诱发其发病的因素较多 ,在国内胆源因素最为常见 ,其次为酒精因素 ,但约有 10 %的急性胰腺炎其原因未明 ,临…     

腹腔镜胆囊切除前后急性胰腺炎的临床特征分析

目的：分析腹腔镜胆囊切除前后急性胰腺炎的临床特点,了解其相关的影响因素。方法回顾性分析30例胆囊切除前急性胆源性胰腺炎（ A组）和30例腹腔镜胆囊切除后急性胰腺炎（ B组）的临床资料。结果 A组的病因均为胆囊结石,且其中24例为胆囊多发小结石;B组占同期所有病因导致急性胰腺炎的8．9％,其中16例为胆源性胰腺炎,6例病因未明,10例为复发性。 A组DBIL／TBIL、GGT异常例数均多于B组（ P均＜0．05）。肝功能检验指标比较两组间差异无统计学意义（ P＞0．05）。结论胆囊切除前急性胆源性胰腺炎的主要病因是胆囊多发小结石,多数病例DBIL／TBIL（＞50％）及GGT高于正常,腹腔镜胆囊切除术后急性胰腺炎的主要病因为胆总管结石,并且具有复发性。     

复发性急性胰腺炎的诊治进展

急性胰腺炎(AP)初发治愈后相当一部分患者有复发倾向。随着影像学和基因检测技术的进展,对可引起AP复发的Oddi括约肌功能障碍、胰腺分裂、相关基因突变等的诊断准确性越来越高。对因治疗可使部分复发性急性胰腺炎(RAP)患者减少复发,临床研究显示内镜治疗在RAP的对因治疗中具有重要作用。本文对RAP病因及其诊治进展作一综述。     

复发性急性胰腺炎临床特征及诊治分析84例

目的:探讨复发性急性胰腺炎(recurrent acutepancreatitis, RAP)的病因, 临床、内镜、影像学表现及治疗.方法:回顾性分析我院2001-9/2007-12收治的84例RAP(复发组)及67例初发性急性胰腺炎(acute pancreatitis, AP)(对照组)患者的临床资料, 包括临床表现、内镜、影像学特征、治疗及预后.结果:复发组中胆道疾患发病率显著高于对照组(60.7% vs 38.8%, P<0.01). 复发组中放射痛、黄疽、肠梗阻的发生率较对照组升高, 但无统计学意义. 复发组胰腺回声粗强者(38.3%)、胰管扩张者(21.3%), 胆囊炎症、结石和胆总管的发生率也显著高于对照组;ERCP复发组发现胆总管结石、扩张者显著高于对照组(35.8% vs 11.6%, 32.1% vs 9.3%,P<0.01或P<0.05). 84例RAP患者中20例手术治疗, 48例保守治疗, 16例内镜治疗, 其中手术治疗和保守治疗各死亡患者3例, 内镜治疗无死亡.结论:RAP最常见病因为胆道疾患、饮食不当、酗酒; 明确病因后积极治疗原发病因, 可有效减少其复发; 内镜下诊断和介入治疗是微创、疗效确切的手段, 值得临床进一步推广.     

复发性急性胰腺炎的病因及治疗方案的选择

目的探讨复发性急性胰腺炎(RAP)的病因及治疗方案的选择。方法回顾性分析内江市第二人民医院2012年1月-2015年12月收治的284例急性胰腺炎(AP)患者,其中初发性急性胰腺炎患者232例(初发组),RAP患者52例(复发组)。收集2组患者的一般情况、病因、复发次数、复发间隔时间、治疗方案及转归情况。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验。结果复发组胆源性因素、高脂血症因素高于初发组(66.8%vs 35.8%,χ2=7.109,P=0.008;17.3%vs 16.0%,χ2=5.818,P=0.007),而饮食因素复发组要低于初发组(7.7%vs 21.1%,χ2=5.046,P=0.025)。复发组52例患者中,复发1次33例(63.46%)、复发2次14例(26.92%)、复发3次及以上5例(9.62%);距初次发病间隔6个月内12例(23.08%),间隔6~12个月内23例(44.23%),间隔12个月及以上17例(32.69%)。RAP组52例患者中23例行手术治疗、23例行保守治疗、6例行内镜治疗,随访观察6~24个月,无死亡病例,无复发病例。结论 RAP病因复杂,其中胆源性因素及高脂血症与AP复发密切相关,治疗上应明确病因,积极对因治疗,可有效降低AP复发率。     

Biliary microcrystals in idiopathic acute pancreatitis: clue for occult underlying biliary etiology

The main causes of pancreatic inflammation worldwide are biliary lithiasis and alcoholism. However, 10 to 30% of patients have been considered to have "idiopathic" acute pancreatitis. Recently, some studies showed that a significant rate of the so called idiopathic pancreatitis are caused by microlithiasis and/or biliary sludge, identified by the presence of cholesterol monohidrate and/or calcium bilirubinate microcrystals in the biliary sediment. In the present study, the analysis of microcrystals from bile obtained during endoscopic retrograde cholangiopancreatography was done in patients with pancreatitis (idiopathic, biliary or alcoholic--20 in each group). Patients with idiopathic pancreatitis and microcrystals in the bile underwent cholecystectomy whenever possible. Those who refused or were inapt to surgery underwent endoscopic sphincterotomy or received continuous therapy with ursodeoxycholic acid. Patients with idiopathic pancreatitis without biliary crystals did not receive any specific treatment. The prevalence of biliary microcrystals in patients with idiopathic pancreatitis (75%) and biliary pancreatitis (90%) was significantly higher than in those with alcoholic pancreatitis (15%). In the identification of the etiology of biliary pancreatitis, the presence of microcrystals had a sensitivity of 90%, specificity of 85%, positive predictive value of 85.7%, negative predictive value of 89.4% and accuracy of 87.5%. In the patients with recurrent idiopathic pancreatitis, with biliary crystals, there was an statistically significant reduction in the number of pancreatitis episodes after specific treatment. In the follow-up of this group during 23.3 +/- 4.8 months, recurrence of pancreatitis occurred only in patients with "persistent biliary factor" (choledocholithiasis and/or persistence of cholesterol monohidrate). All patients with idiopathic pancreatitis who underwent cholecystectomy had chronic cholecystitis. Moreover, cholelithiasis was present in one case. In the ultrassonographic follow-up of the patients with idiopathic acute pancreatitis with microcrystals in the bile, cholelithiasis was detected in one case. In the subgroup of five patients with idiopathic pancreatitis without biliary microcrystals recurrence occurred in one case. Ultrassonographic study during follow-up did not reveal biliary stones in any of these patients. We concluded that the detection of biliary microcrystals in "idiopathic" pancreatitis suggested an underlying biliary etiology, even if occult. What's more, early specific therapeutic procedure (cholecystectomy, endoscopic sphincterotomy or ursodeoxycholic acid) in patients with recurrent idiopathic pancreatitis with microcrystals in the bile reduced significantly the recurrence during the follow-up. Finally, acute pancreatitis (specially recurrent) should not be called idiopathic before the microscopic analysis of the bile, aiming to detect or exclude the presence of microcrystals.     

Recurrent acute pancreatitis and its relative factors

AIM: To evaluate the causes and the relative factors of recurrent acute pancreatitis. METHODS: From 1997 to 2000, acute pancreatitis relapsed in 77 of 245 acute pancreatitis patients. By reviewing the clinical treatment results and the follow-up data, we analyzed the recurrent factors of acute pancreatitis using univariate analysis and multivariate analysis. RESULTS: Of the 245 acute pancreatitis patients, 77 were patients with recurrent acute pancreatitis. Of them, 56 patients relapsed two times, 19 relapsed three times, each patient relapsed three and four times. Forty-seven patients relapsed in hospital and the other 30 patients relapsed after discharge. Eighteen patients relapsed in 1 year, eight relapsed in 1-3 years, and four relapsed after 3 years. There were 48 cases of biliary pancreatitis, 3 of alcohol pancreatitis, 5 of hyperlipidemia pancreatitis, 21 of idiopathic pancreatitis. Univariate analysis showed that the patients with local complications of pancreas, obstructive jaundice and hepatic function injury were easy to recur during the treatment period of acute pancreatitis (P= 0.022<0.05, P= 0.012<0.05 and P= 0.002<0.05, respectively). Multivariate analysis showed that there was no single factor related to recurrence. Of the 47 patients who had recurrence in hospital, 16 had recurrence in a fast period, 31 after refeeding. CONCLUSION: Acute pancreatitis is easy to recur even during treatment. The factors such as changes of pancreas structure and uncontrolled systemic inflammatory reaction are responsible for the recurrence of acute pancreatitis. Early refeeding increases the recurrence of acute pancreatitis. Defining the etiology is essential for reducing the recurrence of acute pancreatitis.     

ERCP在不明原因复发性急性胰腺炎诊治中的作用

目的探讨ERCP在不明原因复发性急性胰腺炎(RAP)诊治中的作用。方法收集15例不明原因RAP患者。其中男5例,女10例,年龄25～65岁,中位年龄38岁,病程1～2年,发病次数2～5次。10例在急性发作期,5例在发作间期行ERCP诊治。结果15例患者经ERCP明确病因者6例(3例胆管微结石,1例胆总管末端小囊肿,1例胰管小结石,1例胰管蛋白栓子),可疑病因者6例(乳头旁憩室2例,十二指肠乳头炎4例),未明确病因者3例。根据ERCP检查结果,9例行乳头括约肌切开术(EST),6例行胰管括约肌切开术。术后随访2年,15例患者均未复发胰腺炎。ERCP和EST术后2例出现一过性高淀粉酶血症,无其他并发症。结论ERCP对不明原因RAP有明确病因和指导治疗的作用。     

急性胆源性胰腺炎115例的临床特征及复发率分析

目的回顾分析急性胆源性胰腺炎(ABP)复发的临床特征及原因。方法对2004-01～2008-07收治的115例ABP患者的临床资料进行回顾性分析。结果 115例的随访观察时间为6～54个月,平均为27.6个月。常规内科治疗组63例,20例复发,复发率为31.7%;内科治疗辅助胆囊切除术组52例,6例复发,复发率为11.5%,常规内科治疗组的复发率高于内科治疗辅助胆囊切除术组(P0.01)。结论切除胆囊能降低胰腺炎复发率,胆总管结石是胆囊切除后胰腺炎复发的主要原因。     

急性胰腺炎病因回顾分析

目的探讨急性胰腺炎患者的发病原因,为急性胰腺炎（AP）的诊治及预防提供依据。方法对我科265例急性胰腺炎患者发病因素进行回顾性分析。结果265例发病患者中,重症急性胰腺炎（SAP）30例,轻症急性胰腺炎（MAP）235例。胆源性77例（29．05％）;酒精性25例（9．43％）、暴饮暴食引起30例（11．32％）、ERCP术后胰腺炎10例（3．77％）、高脂血症性9例（3．40％）、特发性AP53例（20％）,其中与1种因素有关者108例（40．75％）,与2种及以上因素有关者53例（20％）。结论胆道疾病仍是AP主要的病因。AP患者发病因素多而复杂,轻症和重症急性胰腺炎发病因素存在差异。部分患者发病原因仍不明,对于这部分患者应该尽可能寻找病因,以便采取相应防治措施,提高其治愈率,降低复发率。     

EUS for detection of occult cholelithiasis in patients with idiopathic pancreatitis

BACKGROUND: The aim of this study was to evaluate the use of endoscopic ultrasonography (EUS) in detecting occult cholelithiasis and determining a probable etiology in patients classified as having idiopathic pancreatitis by conventional radiologic methods. METHODS: A prospective study was performed in 89 consecutive patients with acute pancreatitis. Transcutaneous ultrasonography (US), CT, or both was performed on all patients within 24 hours of admission. Endoscopic retrograde cholangiopancreatography (ERCP) was performed in all patients with confirmed or suspected biliary pancreatitis. EUS was performed in patients classified as having idiopathic pancreatitis. RESULTS: Cholelithiasis was identified in 64 patients (72%) by conventional radiologic methods. Eighteen patients (20%) were classified as having idiopathic pancreatitis after evaluation by US (all 18 patients), repeated US (9 patients), CT (6 patients) and ERCP (13 patients). EUS performed in these 18 patients revealed small gallbladder stones (1 to 9 mm) in 14 patients; 3 were found to have concomitant choledocholithiasis. All stones were confirmed by subsequent ERCP and cholecystectomy. The remaining 4 patients in whom no etiology was identified had no clinical or radiologic evidence of cholelithiasis at a median follow-up of 22 months. CONCLUSION: Cholelithiasis is detected by EUS in a large number of patients classified as having idiopathic pancreatitis by conventional radiologic examinations. With identification of a biliary cause of acute pancreatitis, treatment can be initiated early, thereby reducing the risk of recurrent pancreatitis with its associated morbidity and mortality. EUS is a valuable diagnostic modality in the management of patients with acute pancreatitis.     

Acute idiopathic pancreatitis: does it really exist or is it a myth?

BACKGROUND: Acute pancreatitis is a severe disease with considerable morbidity and mortality. Gallstones and alcohol abuse are the most frequent causes (75% of patients). Other well-known causes are: hyperlipidemia, hypercalcaemia, abdominal surgery and drugs. In 10%-40% of patients however, no cause is identified after initial diagnostic evaluation: acute idiopathic pancreatitis. Identifying a cause in these patients is important, since the recurrence rate is high. METHODS: A systematic review of the current literature was performed to identify possible causes, diagnoses and treatment options of acute idiopathic pancreatitis. Relevant literature was found via Pubmed. RESULTS: The presence of microlithiasis or biliary sludge is an important cause of acute 'idiopathic' pancreatitis (up to 80% of patients). Microlithiasis and sludge can be detected by transabdominal/endoscopic ultrasonography, ERCP or polarizing light microscopy of bile. Cholecystectomy is the treatment of choice, whereas endoscopic sphincterotomy and ursodeoxycholic acid maintenance therapy are effective alternatives. Sphincter of Oddi dysfunction can be identified as the cause of acute 'idiopathic' pancreatitis in up to 30% of patients. Manometry of Oddi's sphincter is the gold standard for its diagnosis. Endoscopic sphincterotomy prevents recurrence in most patients. Anatomic abnormalities such as major papilla stenosis, pancreas divisum, pancreatic duct strictures and tumours may also cause acute 'idiopathic' pancreatitis. Endoscopic sphincterotomy and surgery are effective treatments. Finally, genetic screening may reveal gene mutations as the cause of acute 'idiopathic' pancreatitis. CONCLUSIONS: Acute 'idiopathic' pancreatitis is a severe disease with a high recurrence rate. Extensive diagnostic investigations may lead to a cause in >90% of patients.     

Endoscopic ultrasound in idiopathic acute pancreatitis

OBJECTIVE: The aim of this study was to determine the utility of endoscopic ultrasound (EUS) in patients with unexplained acute pancreatitis, and whether endoscopic retrograde cholangiopancreatography (ERCP) is subsequently needed. METHODS: Subjects who underwent EUS for assessment of idiopathic acute pancreatitis were identified, their medical records were reviewed, and they were contacted for a follow-up telephone interview. EUS diagnosis was compared with the final diagnosis and outcome. RESULTS: EUS revealed a cause of pancreatitis in 21 of the 31 subjects (68%), including microlithiasis in five (16%), chronic pancreatitis in 14 (45%), pancreas divisum in two (6.5%), pancreatic cancer in one (3.2%), and was not diagnostic in 10 (32%). During a mean follow-up period of 16 months, diagnosis changed in four subjects (13%), and nine subjects (29%) had ERCP because of persistent symptoms or recurrent pancreatitis. CONCLUSION: EUS, a less invasive test than ERCP, demonstrated an etiology in two-thirds of patients with idiopathic acute pancreatitis. Most patients did not require ERCP during the follow-up period. EUS can be an alternative to ERCP in patients with unexplained acute pancreatitis.     

Idiopathic recurrent pancreatitis: long-term results after ERCP, endoscopic sphincterotomy, or ursodeoxycholic acid treatment

OBJECTIVE: In about 30% of cases, the etiology of acute recurrent pancreatitis remains unexplained, and the term "idiopathic" is currently used to define such disease. We aimed to evaluate the long-term outcome of patients with idiopathic recurrent pancreatitis who underwent endoscopic cholangiopancreatography (ERCP) followed by either endoscopic biliary (and seldom pancreatic) sphincterotomy or ursodeoxycholic acid (UDCA) treatment, in a prospective follow-up study. METHODS: A total of 40 consecutive patients with intact gallbladder entered the study protocol after a 24-month observation period during which at least two episodes of pancreatitis occurred. All patients underwent diagnostic ERCP, followed by biliary or minor papilla sphincterotomy in cases of documented or suspected bile duct microlithiasis and sludge, type 2 sphincter of Oddi dysfunction, or pancreas divisum with dilated dorsal duct. Patients with no definite anatomical or functional abnormalities received long-term treatment with UDCA. After biliary sphincterotomy, patients with further episodes of pancreatitis underwent main pancreatic duct stenting followed by pancreatic sphincterotomy if the stent had proved to be effective. RESULTS: ERCP found an underlying cause of pancreatitis in 70% of cases. Patients were followed-up for a period ranging from 27 to 73 months. Effective therapeutic ERCP or UDCA oral treatment proved that occult bile stone disease and type 2 or 3 sphincter of Oddi dysfunction (biliary or pancreatic segment) had been etiological factors in 35 of the 40 cases (87.5%) After therapeutic ERCP or UDCA, only three patients still continued to have episodes of pancreatitis. CONCLUSIONS: Diagnostic and therapeutic ERCP and UDCA were effective in 92.5% of our cases, over a long follow-up, indicating that the term "idiopathic" was justified only in a few patients with acute recurrent pancreatitis.     

Is intervention necessary after a first episode of acute idiopathic pancreatitis?

Acute idiopathic pancreatitis is a term used when no underlying cause has been identified on routine investigation. However, more specialised investigations may identify aetiological factors, biliary sludge and sphincter of Oddi dysfunction for example, in 38-72% of patients with recurrent episodes. Treatment of these abnormalities may prevent further episodes of pancreatitis. The aim of this study was to follow up and determine the outcome in patients with a first episode of idiopathic pancreatitis, and thus determine the need for further investigation and treatment in this group of patients. Thirty one patients with a single episode of idiopathic pancreatitis were studied who had no specialised investigations or specific treatment. During a median follow up of 36 months only one patient has had recurrent pancreatitis. Two patients experienced a single episode of unexplained abdominal pain; serum amylase, liver biochemistry, and abdominal ultrasound were all normal and the pain resolved within 48 hours. In conclusion, in the medium term, the prognosis is good after a first episode of idiopathic pancreatitis and specialised investigation is unnecessary.