18例慢性胰腺炎的诊断及疗效分析

目的探讨慢性胰腺炎的临床特征、诊断和治疗方法,提高对该疾病的认识及诊治水平。方法收集诊断明确的18例CP患者,就发病原因、临床表现及治疗进行分析。结果本组患者的发病原因主要为胆源性、酒精性CP;以上腹痛、消瘦和消化道功能紊乱为主要症状。本组13例经保守治疗症状缓解,5例行外科手术治疗,术后恢复好。结论慢性胰腺炎诊断主要依据致病因素及辅助的影像学检查,治疗上以保守治疗为主,必要时行手术治疗。     

慢性胰腺炎相关因素及处理方法的探讨

目的探讨慢性胰腺炎（CP）的相关因素及最佳处理方法。方法收集本院2005年1月至2008年1月本院确诊为CP住院患者47例,对其相关因素、诊断方法及治疗措施进行回顾性分析。结果CP相关因素中以慢性乙醇中毒为主,47例患者中,酒精性19例（40．43％）,胆源性15例（31．9％）。86．1％的患者经非手术治疗获得症状缓解。结论重度饮酒已成为我国CP的主要致病因素,非手术治疗是目前治疗慢性胰腺炎的主要方法。     

慢性胰腺炎33例临床分析

目的分析与总结慢性胰腺炎（CP）的临床特点与诊治方法，提高对该疾病的认识。方法收集临床或病理证实的33例CP患者，对其病因、临床表现及诊断治疗方法进行对比分析。结果本组酒精性CP多于胆源性，主要症状为腹痛、体质量下降和消化不良。影像学特征主要为胰管扩张、胰腺肿块、假性囊肿、胰腺钙化和胰管结石。本组19例经保守治疗症状缓解，14例外科手术治疗，术后恢复好。结论酒精性CP比例上升。CP临床特征缺乏特异性，影响学检查在CP诊断中起重要作用，病理组织学是确诊的金标准。CP尚缺乏特异性的治疗方法，仍以非手术治疗为主。     

慢性胰腺炎58例临床特点及诊疗分析

慢性胰腺炎(chronic pancreatitis,CP)是一种不同因素造成的以复发性或持续性腹痛及进行性胰腺功能不全,导致胰腺内、外分泌功能丧失的疾病.据文献报道,CP在我国的发病率较低,近年来有增加趋势,最常见的病因是胆道系统的疾病,其次是酒精性[1].CP临床症状无特异性,早期诊断困难,常易误诊、漏诊,加强对本病的认识,开展多种胰腺影像和功能检查,是提高CP诊断和治疗水平的重要途径[2].现将我院1994～2003年间资料完整,经临床诊断及手术病理证实的58例慢性胰腺炎患者的临床资料进行回顾性分析,总结如下.     

慢性胰腺炎182例临床分析

目的:探讨慢性胰腺炎(CP)的病因、临床表现及诊治方法.方法:回顾分析1990年1月～2009年12月的182例CP患者的临床资料.结果:182例患者中胆源性73例,占40.1%,酒精性55例,占30.2%,特发性45例,占24.7%.患者临床表现主要为腹痛,少数伴有腹胀、黄疸、体质量下降、脂肪性腹泻等症状.本组非手术治疗127例,占69.8%,内镜下介入治疗21例,占11.5%,手术治疗34例,占18.7%.结论:胆管系统疾病仍是CP的主要致病因素,非手术治疗是CP主要治疗措施.     

慢性胰腺炎的外科治疗进展

<正>慢性胰腺炎(CP)是临床常见病、多发病。CP病因较复杂,可能与胆道系统疾病、酒精损伤、胰腺损伤、胰腺周围血管病、自身免疫障碍、遗传等因素有关,其中胆道系统疾病是我国慢性胰腺炎常见病因,其次为酒精、急性胰腺炎病史,近年来酒精致病患者逐渐增多。慢性胰腺炎病因、发病机制不尽相同,形态学表现各异,症状可轻可重,诊断困难,临床治疗较复杂。胰腺纤维化进程不可逆,现有的治疗手段均为对症治疗,无法有效祛除病因。手术是处理慢性病以及合并症     

慢性胰腺炎83例诊治分析

目的探讨慢性胰腺炎(chronic pancreatitis CP)的病因及诊治特点。方法回顾分析2001至2008年之间收治的83例CP患者的临床资料。结果 83例患者中,酒精性占35%,胆源性疾病占30%,腹痛为常见症状,确诊CP主要靠影像学检查,70.1%患者经非手术治疗症状缓解。结论酒精性胰腺炎呈增多趋势,影像学检查能明确诊断,非手术治疗是目前治疗CP的主要方法。     

慢性胰腺炎的临床诊治体会

目的:研究慢性胰腺炎(chronic pancreatitis,CP)的致病因素、临床特点及治疗效果,提高慢性胰腺炎的诊治水平。方法:对我院2005年1月～2007年12月收治的117例CP患者的病因及临床表现进行对比分析,并采用药物治疗、内窥镜介入治疗以及手术治疗三种不同的治疗方案进行治疗。结果:药物治疗、内镜治疗以及手术治疗的有效率分别为91.89%、94.74%、91.80%,总有效率为92.31%,各方案治疗有效率组间无显著性差异。结论:慢性胰腺炎症状复杂多样,并发症发生率高,临床治疗应结合患者的个体情况综合判断,选择恰当的方法进行治疗。     

慢性胰腺炎的临床诊治分析

目的：探讨慢性胰腺炎的临床诊治方法以及治疗原则。方法慢性胰腺炎患者18例,搜集其临床诊治方法进行总结分析,并对其临床保守治疗原则进行论述。结果18例慢性胰腺炎患者,胆源性慢性胰腺炎的12例,酒精性的慢性胰腺炎6例。结论早期诊断与治疗是预防慢性胰腺炎急性发作的有效手段,去除发病诱因,采用内外科综合治疗,延缓病情的发展。     

185例慢性胰腺炎的病因及诊治分析

目的分析探讨慢性胰腺炎患者的致病因素及临床治疗效果。方法选取2003年4月至2011年4月期间在我院治疗的胰腺炎患者185例,分别分析了患者的致病因素构成及治疗方法和临床效果。结果 185例慢性胰腺炎患者中,共有致病因素372例,其中,吸烟、胆系疾病和胰腺疾病占前三位,且胆系疾病致病的比例明显高于吸烟和胰腺病变因素,差异显著具有统计学意义(P<0.05),胆系疾病中胆管结石患者比例最高,达到59.8%。手术治疗97例,占52.4%;非手术治疗88例,占47.6%,两种治疗方式的患者症状缓解率分别达到96.9%和96.6%,差异没有统计学意义(P>0.05)。结论引起慢性胰腺炎的因素比较复杂,其中最主要病因为胆系疾病致病,依据病因及症状严重程度对患者采用不同的治疗手段都可以取得良好的临床效果,有利于减轻患者痛苦,提高患者生活质量和医疗质量。     

吸烟在慢性胰腺炎发病中的作用研究

目的分析慢性胰腺炎的致病原因及其相关因素。方法调查了63例慢性胰腺炎患者的临床资料,并对慢性胰腺炎致病原因及相关因素进行分析。结果 63例患者中,慢性胰腺炎与胆系疾病、饮酒、吸烟有明显关系。结论吸烟与慢性胰腺炎的致病因素所占比例较前已有所提高。     

急性胆源性胰腺炎79例临床分析

目的探讨急性胆源性胰腺炎（ABP）临床治疗方法及效果。方法回顾性分析79例ABP的临床资料。结果非手术治疗17例,死亡l例;手术治疗62例,治愈54例,死亡8例。结论以胆道梗阻为主的ABP应急诊手术治疗,无梗阻的ABP应先采用非手术治疗,再择期手术治疗。     

胆源性急性胰腺炎的治疗体会

目的：探讨胆源性急性胰腺炎的手术时机及方式的选择。方法：回顾性总结和分析本院57例胆源性急性胰腺炎的临床资料。采用保守治疗、早期手术治疗和择期手术治疗。结果：本组保守治疗25例,治愈24例,死亡1例;手术治疗32例,治愈29例,死亡3例。结论：早期保守治疗,病情恶化时需急诊手术治疗;保守治疗至病情稳定后,择期手术治疗。选择合适手术时机是＂个体化＂治疗胆源性急性胰腺炎的重要环节。     

Pharmacological manipulation of biliary water and lipids: potential consequences for prevention of acute biliary pancreatitis

Acute biliary pancreatitis, caused by macroscopic cholesterol gallstones or microlithiasis, is often a severe disease with considerable morbidity and mortality. Formation of cholesterol gallstones and microlithiasis is caused by cholesterol crystallization from cholesterol supersaturated gallbladder bile. Particularly patients with fast and extensive crystallization, due to highly concentrated bile, low biliary phospholipid contents and gallbladder mucin hypersecretion seem at risk for pancreatitis. Patients who suffered from acute biliary pancreatitis should undergo cholecystectomy as secondary prevention strategy. For patients at high surgical risk, endoscopic sphincterotomy may be an appropriate alternative. Pharmacological manipulation of biliary lipids by the hydrophilic bile salt ursodeoxycholic acid is reserved for patients with recurrent pancreatitis despite previous cholecystectomy or sphincterotomy, or with contraindications to surgical and endoscopic treatment. Maintenance therapy with ursodeoxycholic acid is however a very effective secondary prevention strategy. Potentially, secondary prevention of acute biliary pancreatitis could also be achieved through decreasing biliary mucin contents by UDCA, NSAIDs or N-acetylcystein, or through achieving bile dilution (currently not feasible).     

胆源性胰腺炎的诊断与外科手术治疗

目的探讨胆源性胰腺炎的临床诊断和手术治疗时机和方法。方法选取本院收治的胆源性胰腺炎病例90例,对其临床资料进行回顾性分析。结果轻症胰腺炎治愈率明显高于重症胰腺炎;死亡5例,均为重症胰腺炎,其中早期手术2例分别死于多脏器功能衰竭和急性呼吸窘迫综合征,晚期手术3例皆死于由于术后继发腹腔严重感染所引发的多脏器功能衰竭;9例出现并发症,早期手术并发症发生率明显高于晚期手术。结论胆源性胰腺炎诊断可根据患者的临床表现结合B超以及CT检查,治疗时应根据患者的具体情况选择手术时机和手术方案。     

老年急性胆源性胰腺炎治疗分析

目的：探讨老年急性胆源性胰腺炎的诊断和治疗办法。方法：回顾性分析27例急性胆源性胰腺炎的临床资料。结果：确诊急性胰腺炎27例,其中男性10例,女性17例。急性充血水肿性胰腺炎26例（96.3％）,急性出血坏死性胰腺炎1例（3．7％）。急诊或早期手术治疗14例,非手术治疗13例,均无死亡,未发生严重并发症,随访时间3个月～4年。结论：B超为急性胆源性胰腺炎的首选检查办法,早期诊断和正确治疗的患者预后良好,梗阻性急性胆源性胰腺炎宜在24～48h内手术治疗。非梗阻性胆源性胰腺炎以保守治疗为宜,病情稳定后1个月再行延期手术。     

Review article: pain and chronic pancreatitis

Background  Pain in chronic pancreatitis chronic pancreatitis is a frustrating and challenging symptom for both the patient and clinician. It is the most frequent and most significant symptom. Many patients fail the currently available conservative options and require opiates or endoscopic/surgical therapy.
Aim  To highlight the pathophysiology and management of chronic pancreatitis pain, with an emphasis on recent developments and future directions.
Methods  Expert review, utilizing in addition a comprehensive search of PubMed utilizing the search terms chronic pancreatitis and pain, treatment or management and a manual search of recent conference abstracts for articles describing pain and chronic pancreatitis.
Results  Pancreatic pain is heterogenous in its manifestations and pathophysiology. First-line medical options include abstinence from alcohol and tobacco, pancreatic enzymes, adjunctive agents, antioxidants, and non-opiate or low potency opiate analgesics. Failure of these options is not unusual. More potent opiates, neurolysis and endoscopic and surgical options can be considered in selected patients, but this requires appropriate expertise. New and better options are needed. Future options could include new types of pancreatic enzymes, novel antinociceptive agents nerve growth factors, mast cell-directed therapy, treatments to limit fibrinogenesis and therapies directed at the central component of pain.
Conclusions  Chronic pancreatitis pain remains difficult to treat. An approach utilizing conservative medical therapies is appropriate, with more invasive therapies reserved for failure of this conservative approach. Treatment options will continue to improve with new and novel therapies on the horizon.     

高脂血症胰腺炎和胆源性胰腺炎发病及治疗康复分析

目的观察高脂血症胰腺炎和胆源性胰腺炎的发病情况对比。方法选取2010年1月～2011年3月在笔者所在医院就诊的胰腺炎患者60例,高脂血症胰腺炎(Ⅰ组)和胆源性胰腺炎(Ⅱ组)患者各30例。分别观察血清淀粉酶、甘油三酯、C反应蛋白、APACHEⅡ评分、CT严重指数、体重指数、治疗后转归及复发情况。结果Ⅰ组与Ⅱ组比较,年龄、AMY显著降低,TG、CRP显著增高,差异有统计学意义(P<0.05),LPS无显著性差异(P>0.05)。Ⅰ组与Ⅱ组比较,APACHEⅡ评分、CT严重指数、体重指数显著增高,差异有统计学意义(P<0.05)。Ⅰ组与Ⅱ组比较,重症比例、6个月内复发率显著增高,手术比例显著下降,差异有显著性(P<0.05)。结论高脂血症胰腺炎与胆源性胰腺炎患者比较,发病年龄轻,病情重,治疗后易复发,早期明确病因,对患者治疗和康复有重要意义。     

Association between chronic pancreatitis and pyogenic liver abscess: a nationwide population study

Background: The relationship between chronic pancreatitis (CP) and subsequent pyogenic liver abscess (PLA) is not well understood.

Methods: We investigated the risk of PLA in patients with CP using inpatient claims data from the Taiwan National Health Insurance Program for the period 2000–2010. We identified 17,810 patients with chronic pancreatitis (CP group) and 71,240 patients without CP (non-CP group). Both cohorts were followed until a diagnosis of PLA, until they were censored from the study because of loss to follow-up, death, or termination of insurance, or until the study cut-off date of 31 December 2011. Incidence and risk factors for development of PLA, and the effects of comorbidities, were assessed.

Results: The incidence of PLA in the CP group was 12.9 times that in the non-CP group (38.3 vs. 2.89 events per 1000 person-years; 95% confidence interval [CI], 10.5–15.8). After adjusting for age, sex, and the comorbidities of hypertension, diabetes, hyperlipidemia, cerebral vascular accident, cirrhosis, heart failure, chronic obstructive pulmonary disease, chronic kidney disease, cancer, alcoholism, other diseases of the pancreas, cholecystitis, and cholelithiasis and other disorders of the biliary tract and endoscopic insertion of stent (tube) into the bile duct, the risk of PLA remained higher among CP patients than among the comparison cohort (adjusted hazard ratio, 6.40; 95% CI, 4.83–8.49). CP patients with five or more comorbidities had a significantly higher risk of PLA (adjusted hazard ratio, 24.9; 95% CI, 18.3–33.8).

Conclusion: CP was associated with increased risk of subsequent PLA. The risk of PLA was higher in patients with five or more comorbidities.