急性胰腺炎119例临床分析

急性胰腺炎 (acute pancreatitis,AP)是一种以胰酶激活和胰腺组织自身消化为主要特征的化学性炎症 ,病变轻重不等 ,重症急性胰腺炎 (severe acute pancreatitis,SAP)病情凶险 ,病死率高达 30 % ～ 6 0 %。近年来随着人民生活水平的提高 ,该病有逐年增加的趋势。本文通过回顾性分析 119例 AP患者的各项临床及实验室指标 ,旨在为临床提供借鉴。材料与方法一、对象经我院病案室计算机检索 ,2 0 0 0年 4月至 2 0 0 1年 12月间诊断为 AP的病例 ,去除临床资料不完整者 ,列入观察共119例 ,男 70例 ,女 4 9例 ,年龄 15 ～ 99岁 ,平均年龄 4 5岁…     

复发性急性胰腺炎42例临床分析

目的探讨复发性急性胰腺炎的病因及诊治。方法回顾性分析42例复发性急性胰腺炎的病因及诊治情况。结果 42例复发病例中,胆源性25例,特发性9例,乙醇性6例,高脂血症、胰腺肿瘤各1例。42例均先行内科保守治疗,其中中转手术治疗14例(均治愈,愈后无复发);28例坚持内科治疗,愈后再次复发9例。本组死亡4例(手术、非手术各2例)。结论急性胰腺炎愈后复发的病因复杂,与疾病及多种药物使用有关,最常见的病因为胆石症、酗酒和暴饮暴食及特发性胰腺炎等有关。明确病因,积极恰当治疗,可减少复发性急性胰腺炎的发生。     

重症急性胰腺炎54例治疗体会

1992～2002年，我们收治重症急性胰腺炎(SAP)患者54例。现将其治疗体会总结如下。     

老年人急性胰腺炎

老年人急性胰腺炎徐世平王孟薇急性胰腺炎是老年人急腹痛的一个重要原因，约占５％～７％。由于老年人急性胰腺炎具有病情重、合并症多、病死率高等特点，因此充分了解和掌握其特点，进行正确及时的诊断和治疗，对减少并发症、提高患者生存率尤为重要。下面就老年人急性胰...     

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.     

急性胰腺炎少见病因分析

目的分析近4年来急性胰腺炎的少见病因组成及发病特点,旨在提高对少见因素所致急性胰腺炎的认识。方法回顾性分析我院2006年1月～2010年2月共436例急性胰腺炎患者的病例资料,统计除胆源性疾病、酒精性等常见原因外的少见原因引起的急性胰腺炎病例共79例,对其病因进行分析。结果特发性急性胰腺炎是少见病因胰腺炎的主要构成部分（62．03％）,高甘油三酯血症（13．92％）、手术（7．59％）在少见病因中所占比例也较高,其它病因少见,但仍有发生。结论急性胰腺炎的少见病因比例虽然少,但病种多样,临床上应注意寻找其可能病因,对因治疗。     

急性胰腺炎151例病因分析

急性胰腺炎 (AP)是由多因素引起的胰酶自身消化所致的化学性炎症性疾病。轻症急性胰腺炎 (AMP)经治疗后数日可完全恢复。少数重症急性胰腺炎 (ASP)病情凶险 ,进展迅速 ,出现多脏器受累 ,易发生腹膜炎、休克、ARDS等多种并发症 ,病死率高 ,属消化科急重症之一。诱发 AP病的病因较多 ,特别是近几年 ,过去一些少见病因所致 AP呈增多趋势。为此 ,我们对山东大学齐鲁医院消化科 1999年 3月～ 2 0 0 2年 6月收入院的 15 1例 AP患者作一病因分析。现报告如下。一般资料 :15 1例 AP患者中 ,男 81例 (5 3.6 % ) ,女 70例(45 .4 % ) ;年龄为 1…     

重症急性胰腺炎内镜治疗进展

重症急性胰腺炎(severe acute pancreatitis,SAP),即急性出血坏死性胰腺炎(AHNP),起病急、进展快、病情危重、复杂多变、并发症多、治疗棘手,死亡率高达40％。近年来注重个体化治疗方案及综合治疗,治愈率明显提高。由于影     

复发性急性胰腺炎的现代诊治观点

复发性急性胰腺炎是指急性胰腺炎的再次发作，而胰腺腺体的形态和功能则正常的疾病。本着重叙述了复发性急性胰腺炎的病因、诊断和病因治疗。     

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。     

Hypertriglyceridemia-induced acute pancreatitis: A prospective,multicenter, international cohort analysis of 716 acute pancreatitis cases

BackgroundHypertriglyceridemia is the third most common cause of acute pancreatitis (AP). It has been shown that hypertriglyceridemia aggravates the severity and related complications of AP; however, detailed analyses of large cohorts are contradictory. Our aim was to investigate the dose-dependent effect of hypertriglyceridemia on AP.MethodsAP patients over 18 years old who underwent triglyceride measurement within the initial three days were included into our cohort analysis from a prospective international, multicenter AP registry operated by the Hungarian Pancreatic Study Group. Data on 716 AP cases were analyzed. Six groups were created based on the highest triglyceride level (<1.7 mmol/l, 1.7–2.19 mmol/l, 2.2–5.59 mmol/l, 5.6–11.29 mmol/l, 11.3–22.59 mmol/l, ≥22.6 mmol/l).ResultsHypertriglyceridemia (≥1.7 mmol/l) presented in 30.6% of the patients and was significantly and dose-dependently associated with younger age and male gender. In 7.7% of AP cases, hypertriglyceridemia was considered as a causative etiological factor (≥11.3 mmol/l); however, 43.6% of these cases were associated with other etiologies (alcohol and biliary). Hypertriglyceridemia was significantly and dose-dependently related to obesity and diabetes. The rates of local complications and organ failure and maximum CRP level were significantly and dose-dependently raised by hypertriglyceridemia. Triglyceride above 11.3 mmol/l was linked to a significantly higher incidence of moderately severe AP and longer hospital stay, whereas triglyceride over 22.6 mmol/l was significantly associated with severe AP as well.ConclusionHypertriglyceridemia dose-dependently aggravates the severity and related complications of AP. Diagnostic workup for hypertriglyceridemia requires better awareness regardless of the etiology of AP.     

急性胰腺炎少见病因分析

目的 分析近年来急性胰腺炎少见病因的变化及发病特点,以增加对少见因素所致急性胰腺炎的认识.方法 回顾性分析我院2008年1月～2012年6月急性胰腺炎患者的病例资料,去除常见病因,并对159例少见病因进行分析.结果 特发性(36.48％)、医源性(19.50％)和胰腺癌(13.21％)是少见病因胰腺炎的主要构成部分;少见病因中发现了嗜酸性胰腺炎等国内外较少报道诱因;少见病因临床发病种类有增多趋势.结论 少见病因胰腺炎发病种类增多,临床上应注意急性胰腺炎少见病因的分析,加强对因治疗.     

Progression to recurrent acute pancreatitis after a first attack of acute pancreatitis in adults

PurposePatients with a first attack of acute pancreatitis (AP) can develop recurrent acute pancreatitis (RAP). Hence, this study aimed to investigate the clinical features of the disease and the risk factors for RAP.MethodsWe performed a retrospective study of 522 patients from Jan 1 to Dec 31, 2006. All patients with AP were followed for 36 months. The primary end point was the rate of RAP. The secondary end points were the risk factors that were evaluated by Cox regression analysis. The cumulative risk of RAP was assessed using Kaplan-Meier analysis.Results56 of the 522 patients (10.7%) developed RAP. Among those RAP patients, 37 (7.1%) experienced one relapse, 10 (1.9%) experienced two relapses, and 9 (1.7%) experienced three or more relapses. Univariate analysis indicated that age (p = 0.016), male sex, etiology of AP (p = 0.001), local complications (p = 0.001) and Length of stay (LOS) (p = 0.007) were associated with RAP. Multivariate analysis with the Cox proportional hazards model showed that male sex (HR = 2.486, 95% CI, 0.169–0.960, p = 0.04), HTG-associated etiology (HR = 5.690, 95% CI, 2.138–15.146, p = 0.001), alcohol-associated etiology (HR = 5.867, 95% CI, 1.446–23.803, p = 0.013) and current local complications at index admission (HR = 8.917, 95% CI, 3.650–21.789, p = 0.001) were significant independent risk factors for RAP.ConclusionsA first attack of AP led to RAP in 10.7% of patients within 3 years. Male sex was significantly associated with RAP. The etiologies of alcohol and HTG and local complications were the strongest risk factors for recurrent disease. Patients with these characteristics should be given special attention and followed-up closely.     

善得定治疗急性胰腺炎临床对照分析

目的 探讨善得定治疗急性胰腺炎的临床疗效。方法 将34例急性胰腺炎患者随机分为2组,17例用善得定每小时25μg,另17例不用善得定,对照临床症状改善情况及Ranson预后指标。结果 善得定治疗组中腹痛完全消失者较多,镇痛药应用较少,且48h后不良预后指标较少,包括血球压积降低10％以上和血钙＜8mg/dL的患者显著少于对照组。结论 用善得定治疗急性胰腺炎可减轻症状,减少并发症,并防止病情恶化。     

Evaluation of Chinese updated guideline for acute pancreatitis on management of moderately severe and severe acute pancreatitis

Background/Objectives: The management of acute pancreatitis (AP) in China has undergone major changes since the launch of the updated guideline in 2013. This study aimed to evaluate the impact of this guideline on clinical practice and patient outcome.MethodsModerately severe and severe adult AP patients, who were admitted to Peking Union Medical College Hospital from January 1, 2001 to December 31, 2016, were retrospectively included in the study. All enrolled patients were divided into two groups based on the publication date of the updated guideline, as the pre-guideline (Pre) group and post-guideline (Post) group. In-hospital case-fatality rates were compared between two groups after adjusting baseline features, including gender, age, etiology and disease severity. In addition, the associations between specific therapeutic approaches recommended in the updated guideline and in-hospital case-fatality rates were explored.ResultsA total of 475 patients were enrolled in this study, including 273 (57%) in the Pre group and 202 (43%) in the Post group. The adjusted in-hospital case-fatality rate significantly decreased in the Post group (14.3% vs. 5.9%, OR 0.39, 95%CI 0.19–0.82). In the post-hoc analysis, the use of enteral nutrition was a protective factor against in-hospital death (OR: 0.08, 95%CI: 0.03–0.18), while open surgery showed an opposite effect (OR: 3.81, 95%CI: 1.06–13.74). Prophylactic antibiotics was not significantly associated with in-hospital death (OR: 1.00, 95%CI: 0.39–2.60).ConclusionsThere was a prominent transition in the management of moderately severe and severe AP after the release of the guideline in China in 2013, which made the prognosis better.     

Últimos avances en pancreatitis aguda

The present article analyzes the main presentations on acute pancreatitis (AP) in Digestive Disease Week 2013. Perfusion computed tomography allows early diagnosis of pancreatic necrosis. Neutrophil gelatinase-associated lipocalin predicts the development of acute renal failure, severe AP and death. Factors associated with greater fluid sequestration in AP are alcoholic etiology, an elevated hematocrit, and the presence of criteria of systemic inflammatory response syndrome; fluid sequestration is associated with a worse outcome. True pseudocysts (fluid collections without necrosis for more than 4 weeks) are a highly infrequent complication in AP. Patients with necrotic collections have a poor prognosis, especially if associated with infection. A meta-analysis on fluid therapy suggests that early aggressive fluid administration is associated with higher mortality and more frequent respiratory complications. According to a meta-analysis, enteral nutrition initiated within 24 hours of admission improves the outcome of AP compared with later initiation of enteral nutrition. Pentoxifylline could be a promising alternative in AP; a double-blind randomized study showed that this drug reduced the length of hospital and intensive care unit stay, as well as the need for intensive care unit admission. The association of octreotide and celecoxib seems to reduce the frequency of organ damage compared with octreotide alone. Mild AP can be managed in the ambulatory setting through hospital-at-home units after a short, 24-hour admission.     

Acute pancreatitis in children and adolescents

In this Topic Highlight, the causes, diagnosis, and treat-ment of acute pancreatitis in children are discussed. Acute pancreatitis should be considered during the dif-ferential diagnosis of abdominal pain in children and requires prompt treatment because it may become life-threatening. The etiology, clinical manifestations, and course of acute pancreatitis in children are often differ-ent than in adults. Therefore, the specific features of acute pancreatitis in children must be considered. The etiology of acute pancreatitis in children is often drugs, infections, trauma, or anatomic abnormalities. Diagnosis is based on clinical symptoms(such as abdominal pain and vomiting), serum pancreatic enzyme levels, and im-aging studies. Several scoring systems have been pro-posed for the assessment of severity, which is useful for selecting treatments and predicting prognosis. The basic pathogenesis of acute pancreatitis does not greatly dif-fer between adults and children, and the treatments for adults and children are similar. In large part, our under-standing of the pathology, optimal treatment, assess-ment of severity, and outcome of acute pancreatitis in children is taken from the adult literature. However, we often find that the common management of adult pan-creatitis is difficult to apply to children. With advances in diagnostic techniques and treatment methods, severeacute pancreatitis in children is becoming better under-stood and more controllable.     

Effectiveness and therapeutic value of phytochemicals in acute pancreatitis: A review

BackgroundAcute pancreatitis (AP) is an inflammatory disorder of the pancreas that can lead to local and systemic complications. Repeated attacks of AP can lead to chronic pancreatitis, which markedly increases the probability of developing pancreatic cancer. Although many researchers have attempted to identify the pathogenesis involved in the initiation and aggravation of AP, the disease is still not fully understood, and effective treatment is limited to supportive therapy.MethodsWe aim to summarize available literature focused on phytochemicals (berberine, chlorogenic acid, curcumin, emblica officinalis, ellagic acid, cinnamtannin B-1, resveratrol, piperine and lycopene) and discuss their effectiveness and therapeutic value for improving AP.ResultsThis study is based on pertinent papers that were retrieved by a selective search using relevant keywords in PubMed and ScienceDirect databases.ConclusionsMany phytochemicals hold potential in improving AP symptoms and may be a valuable and effective addition to standard treatment of AP. It has already been proven that the crucial factor for reducing the severity of AP is stimulation of apoptosis along with/or inhibition of necrosis. Supplementation of phytochemicals, which target the balance between apoptosis and necrosis can be recommended in ongoing clinical studies.     

高脂血症性急性胰腺炎与胆源性胰腺炎的临床对比分析

目的对比分析高脂血症性急性胰腺炎（hyperlipidemic acute pancreatitis,HLAP）与急性胆源性胰腺炎（acute biliary pancreatitis,ABP）的临床特点。方法回顾性对比分析我院2005年8月～2010年8月间收治的28例HLAP和64例ABP患者的临床资料。结果 HLAP组BMI、重症患者比例、Ranson评分≥3、CT分级为D、E及APACHEII≥8分者均较ABP组高（P〈0.05）。HLAP组血清TG、GLU、UA均显著高于ABP组,而ALT、AKP、TBIL、DBIL及血AMY均显著低于ABP组（P〈0.05）。两组患者平均住院时间无统计学差异（P〉0.05）。HLAP组患者死亡率为14.3%）,显著高于ABP组的1.5%（P〈0.05）。结论与ABP组相比,HLAP组通常病情较重,多为SAP且常不伴有血淀粉酶的显著升高,且死亡率高。