漫漫胰腺路——慢性胰腺炎诊治的热点和难点

<正>慢性胰腺炎(chronic pancreatitis,CP)是一种由遗传、环境等因素引起的胰腺组织慢性炎症性疾病,其病因及发病机制复杂,早期诊断困难,临床治疗难度大,患者身心健康受损,生活质量明显下降。CP的诊治是世界性难题,尚有许多待研究、待解决的问题。CP全球发病率约为9.62/10万人,患病率为(13.5～560)/10万人,全球大部分国家和地区CP的发病率与患病率均呈上升趋势^[1]。我国仅在2009年发表了一项CP患病率的抽样调查研究,目前亟需进行更多基于一般人群的队列研究以获得CP发病率和患病率的可靠数据。CP病因复杂,目前的病因分类系统主要有TIGAR-O及M-ANNHEIM分类等,     

急慢性胰腺炎——第10讲 慢性胰腺炎的外科治疗

慢性胰腺炎（CP）是以存在不可逆的胰腺形态学改变并伴有疼痛或永久性功能丧失为特征的炎性病变,在胰腺病变中所占比例较大,近几年来发病率呈上升趋势,且难以彻底治愈,根据病情特点,当出现剧烈顽固性疼痛,经内科治疗无效者;出现慢性胰腺炎的并发症包括：胆总管下端受压导致阻塞性黄疸;假性胰腺囊肿继续增大引起胃肠受压;创伤导致慢性胰腺炎合并顽固性胰瘘时选择合适时机进行外科手术,是较理想的治疗方法。概括起来主要方法及疗效评价如下。     

急慢性胰腺炎第10讲慢性胰腺炎的外科治疗

慢性胰腺炎(CP)是以存在不可逆的胰腺形态学改变并伴有疼痛或永久性功能丧失为特征的炎性病变,在胰腺病变中所占比例较大,近几年来发病率呈上升趋势,且难以彻底治愈,根据病情特点,当出现剧烈顽固性疼痛,经内科治疗无效者;出现慢性胰腺炎的并发症包括:胆总管下端受压导致阻塞性黄疸;假性胰腺囊肿继续增大引起胃肠受压;创伤导致慢性胰腺炎合并顽固性胰瘘时选择合适时机进行外科手术,是较理想的治疗方法.概括起来主要方法及疗效评价如下.     

急性胰腺炎的临床诊疗

胰腺炎是一组常见的胰腺疾病,包括急性胰腺炎和慢性胰腺炎.胰腺假性囊肿为胰腺疾病的常见并发症,多与急性胰腺炎或慢性胰腺炎有关.     

奥曲肽不同给药途径治疗重症急性胰腺炎的疗效比较

急性胰腺炎（acute pancreatitis，AP）是指多种病因引起的胰酶激活，继以胰腺局部炎症反应为主要特征，伴或不伴有其他器官功能改变的疾病。随着生活水平的提高和饮食结构的改变，尤其是饮酒量和高脂饮食的增加，胰腺疾病在全球范围内的发病率呈逐年增高趋势。尤其是重症急性胰腺炎（SAP），发病快，病情复杂多变，并发症多，死亡率高，     

胰腺外科的现况

<正> 我国最常见的胰腺疾病是急性胰腺炎,约占急腹症的3—5位。其次是胰腺癌,近年来发病率有增高趋势,占各类癌肿的第十二位,据上海1977年统计,发病率为3.8/10万人。再其次为慢性胰腺炎;胰腺囊肿也不少见。胰岛素瘤至1981年已有501例经外科治疗。胰胰脓肿、胃泌素瘤、胰高糖素瘤(A 细胞)、非功能性胰岛细胞瘤、胰腺囊腺瘤和胰腺囊腺癌均有报告。     

慢性胰腺炎及其外科治疗的现状

慢性胰腺炎是胰腺进展性的不可逆的炎症性疾病，有不同的病因和临床表现。lop年讪阳初见胰腺炎专题会议将慢性胰腺炎与急性胰腺炎进行了分类。指出了慢性胰腺炎胰腺的一些不可逆的改变，并采取一些外分泌与内分泌的功能检查来诊断慢性胰腺炎。由于慢性胰腺炎往往涉及到胶胆管的病变和出现顽固性腹痛［1］，53％的慢性胰腺炎病人需外科处理。因此，慢性胰腺炎也是近年来欧美外科界广泛注意和讨论的题目之一。1发病率及病因虽然漫性胰腺炎的发病率及病因，在世界不同的地区有所不同。但一般公认，慢性胰腺炎的发病率在近对年来有所增加。但由…     

慢性胰腺炎疼痛的处理：内镜还是外科手术？

<正>慢性胰腺炎(chronic pancreatitis,CP)是一种由遗传、环境等因素引起的胰腺组织慢性炎症性疾病,其病理特征为胰腺腺泡萎缩及纤维化,临床表现为上腹痛、胰腺内外分泌功能不全伴假性囊肿等并发症^[1-2]。在全球范围内,CP发病率为9.62/10万,患病率为(36～560)/10万^[3-6],死亡率为0.09/10万,CP患者以男性为主,男性患者数量约为女性的2倍^[7]。CP发病率有逐年上升趋势,这可能与腹膜后疾病诊断技术包括CT、磁共振、超声内镜等的应用逐渐增多相关^[8-9]。CP的治疗原则包括去除病因、控制症状、改善胰腺功能、防治并发症以及提高生活质量。疼痛是CP患者最常见的临床症状,而疼痛模式是决定临床采取何种治疗手段的关键因素,     

老年慢性胰腺炎

老年慢性胰腺炎的发病率不详。在我国,胆系疾病为慢性胰腺炎的主要原因,老年人胆系疾病的发病率并无下降,故推测我国的老年慢性胰腺炎的发病率可能较高,准确统计数字尚待进一步调查。老年人胰腺的腺体萎缩、纤维化及胰管上皮细胞增生等生理性退行性变化,与慢性胰腺炎之病变相重叠,给此项研究带来一定困难。目前研究资料表明,老年慢性胰腺炎的临床特点有:     

慢性胰腺炎的临床治疗

慢性胰腺炎是以胰腺实质内腺泡和小管的反复或持续性损害,胰腺广泛性纤维化,局灶性坏死及胰腺导管内结石形成或弥漫性钙化,腺泡和胰岛细胞的萎缩或消失为特征.发病率约为0.04%～5%,50～59岁男性和60～69岁女性多见.     

复发性急性胰腺炎的病因及内镜治疗进展

近年来,复发性急性胰腺炎(RAP)的发病率逐年上升,由于病因的复杂性及诊治水平的限制等,造成了复发率及慢性化发生率亦有上升的趋势,故尽早明确病因,积极对因治疗则成为改善该趋势的关键。目前,内镜治疗在国内外广泛开展,且对于梗阻性RAP具有其独特的优势,在RAP众多的治疗方法中占据了极其重要的地位。现就RAP的病因和内镜治疗进展予以综述。     

磁共振对慢性胰腺炎诊断的临床研究进展

慢性胰腺炎（chronic pancreatitis CP）在我国的发病率呈逐年增高的趋势,其诊断除结合病史、临床表现外,主要通过影像学检查。由于磁共振图像(Magnetic resonance imaging MRI)含有独特的化学结构信息,被认为比超声、计算机断层扫描(Computed Tomography CT)具有更大的潜在优越性,是近年来一种有价值的倍受注目的新技术。MRI精髓在于不但能显示形态学改变,亦能反应组织器官的功能性变化,有可能提供生化过程的信息和动态的定量资料。本文就目前临床上运用磁共振(Magnetic resonance MR)诊断CP方面的研究现况作一综述。     

胰管结石体外震波碎石治疗进展

胰管结石在临床上相对少见,大多继发于慢性胰腺炎,是慢性胰腺炎的常见并发症。随着慢性胰腺炎发病的增多及内镜诊疗技术的不断提高,胰管结石的发病率和检出率不断提高。内镜治疗慢性胰腺炎的目的是减轻主胰管压力,缓解慢性胰腺炎所引起的腹痛等症状。体外震波碎石可以改善内镜下主胰管引流的效果,并扩大了内镜治疗慢性胰腺炎的适应证。体外震波碎石治疗胰管结石引起的慢性胰腺炎是安全有效的。     

全球结核病的流行与控制

结核病是一个全球性的疾病,在被忽略近20年后又死灰复燃,成为当今世界一个主要的公共卫生问题.1993年,世界卫生组织因结核病的流行规模及控制全球结核病的迫切需要,宣布全球进入结核病紧急状态.中国是世界上人口最多的国家,位居全球结核病感染最严重的22个国家之首位.在20世纪80年代中晚期,美国也终止了其长期以来结核病的下降趋势,1992年美国结核病的发病率达到一个高峰.撒哈拉以南非洲地区是世界结核病例分布最多的三个区域之一,世界结核病发病率最高的15个国家有13个在这个地区内,并且HIV是这一区域结核病发病率最主要的单一预计因子.世界最严重的HIV相关结核病发病也是在这个区域.全球持续的严重结核感染状态,是由于贫困人口的增加和来自于结核高发病率国家的人口流动和HIV的影响,最主要的是没有维持必需的公共卫生组织及设施,以及错误的认为结核病已成为一个过去的问题.依靠现有的诊断和治疗方法,WHO推荐的DOT方案有效而经济,适用于全球在不同条件下的结核控制.     

我国慢性病患病率的社会人口学分析

目的：了解我国慢性病患病率的社会人口学特征以及分布规律。方法：以三次全国卫生服务调查数据为基础,对收集的资料进行深入分析与讨论。结果：慢性病患病率呈逐年上升趋势,城市慢性病患病率高于农村,慢性病患者中老年人口居多。结论：医疗保险机构应对慢性病患者给予一定的门诊报销或补偿,政府应加强社区卫生服务机构对慢性病患者的健康管理,以期进一步预防与控制慢性病的发病率。     

The diabetes epidemic in Sri Lanka - a growing problem

Diabetes mellitus, which was once considered a disease of the developed world, has become a worldwide pandemic, with two thirds of the global diabetic population living in the developing countries. Local studies show a definite upward trend in the prevalence of diabetes mellitus. The earliest available study on a rural community in 1990 reported a prevalence of 2.5%. The largest-ever study on the diabetes prevalence in Sri Lanka was published in 2005. It showed a prevalence of 14.2% among males and 13.5% among females. The World Health Organisation and the International Diabetic Federation estimates and forecasts are much lower than the available local prevalence rates, and what may be predicted from the prevalence rates in South India. Further research is necessary to investigate the exact underlying mechanisms for the South Asian epidemic. Wider preventive programmes need to be urgently implemented to stem the tide.     

急性胰腺炎的胃粘膜病变

目的：研究急性胰腺炎的胃粘膜病变特点及与幽门螺杆菌（HP）感染的关系。方法：慢性胃炎诊断标准参照最新悉尼分类系统，幽门螺杆菌检测采用快速尿素酶试验，病理组织学染色及^13C呼气试验。结果：急性胰腺炎患者胃粘膜病变发生率高，其幽门螺杆菌感染率与慢性胃炎患者无显著性差异。结论：急性胰腺炎可导致胃粘膜病变，幽门螺杆菌感染不是其直接原因。     

Tropical chronic pancreatitis

Tropical chronic pancreatitis (TCP) is a juvenile form of chronic calcific non-alcoholic pancreatitis, seen almost exclusively in the developing countries of the tropical world. The classical triad of TCP consists of abdominal pain, steatorrhoea, and diabetes. When diabetes is present, the condition is called fibrocalculous pancreatic diabetes (FCPD) which is thus a later stage of TCP. Some of the distinctive features of TCP are younger age at onset, presence of large intraductal calculi, more aggressive course of the disease, and a high susceptibility to pancreatic cancer. Pancreatic calculi are the hallmark for the diagnosis of TCP and in non-calcific cases ductal dilation on endoscopic retrograde cholangiopancreatography, computed tomography, or ultrasound helps to identify the disease. Diabetes is usually quite severe and of the insulin requiring type, but ketosis is rare. Microvascular complications of diabetes occur as frequently as in type 2 diabetes but macrovascular complications are uncommon. Pancreatic enzyme supplements are used for relief of abdominal pain and reducing the symptoms related to steatorrhoea. Early diagnosis and better control of the endocrine and exocrine dysfunction could help to ensure better survival and improve the prognosis and quality of life of TCP patients.     

Epidemiology of type I diabetes mellitus among Arab children

In this article, the epidemiology of type 1 diabetes mellitus among Arab children (<15 years) living in Arab and non-Arab countries is reviewed. These data include the incidence, prevalence and etiopathogenic factors including genetics, environmental factors as well as autoimmune disease markers aside from clinical presentation at onset. The review is based on the information from publications in the international literature identified by searching Medline, other websites as well as personal experience and some communications. The obtained data suggest that the incidence of type 1 diabetes in these countries is increasing similar to the experience in other parts of the world. High incidence has been reported among Arab children who immigrated to some Western countries. The highest incidence is in Qatar and Kuwait and the lowest is in Oman and Jordan. There is considerable variation among countries, which could not be explained on genetic or climatic variations alone. Other environmental factors particularly nutritional ones including high intake of dairy products and vitamin D deficiency are possibly operating. Further, nationwide research from different countries covering the rural as well as urban areas and different ethnic intermixes are needed. To overcome financial and facility problems that hinder research; some cooperation between these countries as well as international bodies are needed.     

Trends in etiologies of chronic pancreatitis within 20 years: analysis of 636 cases

Background  The prevalence of chronic pancreatitis has increased during recent years in Asia-Pacific areas as well as in China. The etiologies vary in different regions and periods. This study aimed to investigate the changing etiologies of chronic pancreatitis within 20 years at Peking Union Medical College Hospital in China.

Methods  Retrospective analysis of the etiologies of 636 cases of chronic pancreatitis at Peking Union Medical College Hospital from 1990 to 2010 was performed. Patients were divided into two groups according to two time periods (1990–2000 and 2001–2010). Statistical analysis was performed using the chi-square test.

Results  The morbidity rate of chronic pancreatitis in China has recently increased. The main etiology changed from biliary diseases in the 1990s (decreased from 36.8% to 28.1%) to alcohol abuse after the year 2000 (increased from 26.5% to 36.8%). The main etiology of biliary diseases is stones in the cholecyst or bile duct, and the percentage of cholecystitis cases has increased. Autoimmune disease, including autoimmune pancreatitis, has increased quickly and currently accounts for 7.3% of cases because a greater number of autoimmune pancreatitis cases are being diagnosed. Approximately 9.5% of chronic pancreatitis cases are caused by multiple factors such as alcohol abuse and bile duct stones. Other factors include cholecystectomy and acute pancreatitis.

Conclusions  The main etiology of chronic pancreatitis has changed from biliary disease to alcohol abuse in recent years. Autoimmune factors have also obviously increased.