急性胰腺炎与慢性胰腺炎

随着人们生活水平的提高,胰腺炎的发病率在逐年上升.过去的几年里,虽然胰腺炎的研究取得了很大的进展,但仍存在许多争议的问题.其中急性胰腺炎(AP)与慢性胰腺炎(CP)的关系尤其是AP是否能向CP演变,以及演变的机制等都还不甚清楚.     

急性胰腺炎与慢性胰腺炎

随着人们生活水平的提高,胰腺炎的发病率在逐年上升。过去的几年里,虽然胰腺炎的研究取得了很大的进展,但仍存在许多争议的问题。其中急性胰腺炎(AP)与慢性胰腺炎(CP)的关系尤其是AP是否能向CP演变,以及演变的机制等都还不甚清楚。     

Surgical approaches to chronic pancreatitis

Chronic pancreatitis (CP), a benign, inflammatory process of the pancreas, can cause severe pain, diabetes mellitus, steatorrhoea, and weight loss and often leads to a significant reduction in the quality of life. In the past decade our knowledge of the pathophysiology of CP has increased together with the number and quality of treatment options available for this disease. In addition to pharmacological and endoscopic treatment modalities, surgical drainage and resection procedures have become increasingly important since they have the potential to provide superior long-term results in patients with CP. The classical and pylorus-preserving pancreaticoduodenectomy, once the standard operations for patients with CP, have been replaced by organ-sparing procedures like the duodenum preserving pancreatic head resection and its variants. The latter allow better preservation of the exocrine and endocrine pancreatic function, and provide adequate pain relieve and improvement in the quality of life of CP patients.     

Corticosteroids prevent the progression of autoimmune pancreatitis to chronic pancreatitis

Background/objectivesPatients with autoimmune pancreatitis (AIP) sometimes progress to chronic pancreatitis (CP). We evaluated the ability of corticosteroids to prevent the progression to CP.MethodsWe defined patients with definitive findings of CP (stones in the main pancreatic duct [MPD] or multiple pancreatic calcifications) as having severe calcification (SC). A total of 145 AIP patients were enrolled. We measured the duration between AIP diagnosis and SC development and retrospectively compared the time to SC development between patients with and without steroids. Multivariate analysis for factors associated with SC were performed.ResultsNineteen (13%) patients progressed to SC. Since 95 patients had pancreatic head swelling and SC was found in these patients only, our analysis focused mainly on these at-risk populations. In Kaplan-Meier analysis limited to patients with pancreatic head swelling, the incidence of SC was significantly lower in patients with steroids than in those without (hazard ratio [HR] 0.18, 95% confidence interval [CI] 0.07–0.52; p < 0.001). Multivariate testing of patients with pancreatic head swelling confirmed that steroid therapy was significantly associated with a lower incidence of SC (HR 0.11, 95% CI 0.03–0.34; p < 0.001), while MPD dilation at AIP diagnosis was related to a higher incidence of SC (HR 4.02, 95% CI 1.43–11.7; p = 0.009).ConclusionsCorticosteroids appeared to prevent progression to CP in AIP patients, especially in those with pancreatic head swelling. Patients with both pancreatic head swelling and MPD dilation at diagnosis have a higher incidence of progression to CP. Steroid therapy is suggested for these high-risk cases.     

慢性胰腺炎诊治指南

慢性胰腺炎(chronic pancreatitis, CP)是指由于各种不同病因引起胰腺组织和功能的持续性损害,其病理特征为胰腺纤维化.临床以反复发作的上腹疼痛,胰腺外分泌功能不全为主要症状,可并有胰腺内分泌功能不全、胰腺实质钙化、胰管结石和胰腺假性囊肿形成.国内缺乏流行病学统计资料.     

慢性胰腺炎诊治指南（2005年南京）

慢性胰腺炎(chronic pancreatitis，CP)是指由于各种不同病因引起胰腺组织和功能的持续性损害，其病理特征为胰腺纤维化。临床以反复发作的上腹疼痛，胰腺外分泌功能不全为主要症状，可并有胰腺内分泌功能不全、胰腺实质钙化、胰管结石和胰腺假性囊肿形成。国内缺乏流行病学统计资料。     

Genetic predisposition to alcoholic chronic pancreatitis

The mechanisms leading to alcoholic chronic pancreatitis in humans have remained elusive. Numerous questions surround the apparent random nature of the disease in which 1 person is hit with alcoholic chronic pancreatitis while the next is spared. Why do fewer than 10% of chronic, heavy alcohol users ever develop pancreatitis, while others develop alcoholic liver disease, neuropathy, or other alcohol-associated problems? Why do laboratory animals, fed large amounts of alcohol for prolonged periods of time, fail to develop typical chronic pancreatitis? Why are heavy alcohol users from a black African background more likely to develop pancreatic diseases than Caucasians, whereas the opposite is true for the development of liver disease? The answers underlying these questions appear to reflect the differences in underlying genetic susceptibility, environmental exposure, and the interaction between these factors. Thus, even cases of "typical" alcoholic chronic pancreatitis or other forms of pancreatitis appear to be complex diseases. Recently, several genetic mutations have been identified that increase the susceptibility to pancreatitis. However, the major common gene mutations in CFTR, PRSS1, and SPINK1 only slightly increase the risk of alcoholic chronic pancreatitis. New genetic, environmental, and triggering factors must be considered to gain further insight into the mechanisms leading to alcoholic chronic pancreatitis so that strategies for treatment and prevention can be developed.     

Appendicectomy for recurrent and chronic appendicitis

In recent years, several reports have underlined the possible existence of chronic appendicitis. Up to 38% of spontaneously resolving acute appendicitis may recur. We studied 41 patients operated on between July 2000 and June 2001 for chronic and recurrent appendicitis at a teaching hospital in the city of Nairobi. The patients comprised 17.8% of all patients undergoing surgery for appendicitis during the study period. The majority (65.9%) were females. The faecolith rate was 51.2%. About half of appendices removed for these symptoms were normal at histology. Nearly 70% of the normal appendices contained faecoliths. Symptoms resolved in 90% of faecolith-containing appendices and 87.5% of non-faecolith-containing appendices that were normal on histology.     

Surgical approaches to treatment of chronic pancreatitis

In the treatment of pancreatitis in recent decades various surgical methods are used. Essentially we can divide them into resection and drainage methods. In the submitted paper the authors review possible surgical treatment of chronic pancreatitis and indications of optimal surgical methods in different forms of chronic pancreatitis. The application of these surgical procedures is demonstrated on a group of patients operated by the authors in 1985-2001. The authors discuss the problem of indication of patients for surgical treatment and selection of the optimal surgical methods for the treatment of chronic pancreatitis.     

胆石症与慢性胰腺炎

胰腺炎病因存在明显的地域特征，因地理环境、经济状况和生活习惯不同而存在较大差异，“国人急性胰腺炎(AP)以胆石症为主，西方国家以酒精性为主”的结论已成共识。尽管慢性酒精中毒已成为公认慢性胰腺炎(CP)的常见原因，但近20多年来，我国学者一直认为CP与同时存在的胆道疾患(胆石症、胆囊炎和胆总管疾病等)密切相关。胆石能否成为CP病因，我国学者与欧美以及亚洲一些学者存在不同观点，而分歧焦点在于胆石症是CP的病因，还是CP的伴发疾病或危险因素。     

胆石症与慢性胰腺炎

胰腺炎病因存在明显的地域特征,因地理环境、经济状况和生活习惯不同而存在较大差异,"国人急性胰腺炎(AP)以胆石症为主,西方国家以酒精性为主"的结论已成共识.     

慢性阑尾炎腹腔镜手术治疗

目的 探讨腹腔镜下慢性阑尾炎治疗的可行性、方法和效果。方法 选择8例慢性阑尾炎病人行腹腔镜阑尾切除术。结果 8例均成功完成腹腔镜手术。平均手术时间30min，术中几乎不出血。术后胃肠功能平均恢复时间分别1．2d。术后平均进流质时间6h。无一例中转开腹，无一例手术并发症。结论 慢性阑尾炎行腹腔镜手术治疗安全、可行，具有创伤小、术后恢复快等微创手术优势，可获得与开腹手术相同的疗效。