加强慢性胰腺炎的基础与临床研究

在诸多的胰腺疾病中,慢性胰腺炎(chronicpancreatitis,CP)是一个不可忽视的领域,由于其发病机理不清,目前尚无特异的诊断方法与有效的治疗措施,因而至今CP仍然是困扰人们生活质量的一     

老年重症急性胰腺炎与慢性胰腺炎的治疗

老年人急性胰腺炎比中青年轻，重症胰腺炎的ＣＴ分级多数为Ｂ级与Ｃ级，很少有Ｄ级与Ｅ级，这可能是老年人的反应性较低下之故。但是老年人有动脉硬化，胰动脉硬化、缺血及胆石症发生率较高，即使脂食摄入量不多也容易诱发急性胰腺炎，甚至慢性胰腺炎。由于老年人多有心血...     

慢性胰腺炎——病因、发病机制及治疗的认识现状

慢性胰腺炎（ｃｈｒｏｎｉｃ Ｐａｎｃｒｅａｔｉｔｉｓ，ＣＰ）是一种全球性常见疾病。在西方国家，其流行率为１０～1５／１０万，发病率为４～５／１０万［１］。然而，这些数据可能被低估了，因为在现场研究中ＣＰ的诊断并不是根据先进诊断技术，如ＣＴ扫描和内镜逆行胰胆管造影（ＥＲＣＰ）等。确实，日本最近一项根据先进影像学技术的研究所报道的ＣＰ流行率和发病率（分叼为４５．４／１０万和１４．５／１０万）远高于上述数据［２］。这些数据通常是反映酒精性ＣＰ的流行率，与这些国家中的酒精消费量相对应。然而，在某些地区ＣＰ…     

急性胰腺炎诊断和治疗进展

急性胰腺炎(acute pancreatitis,AP)是临床常见的消化系统急症,发病因素复杂,目前确切的发病机制尚未完全阐明,而重症急性胰腺炎(severe acutepancreatitis,SAP)预后差,病死率高,及时诊断、去除引起疾病发作的病因,能有效地预防再发作,促进胰腺功能和形态的恢复,避免SAP。近年来尽管基础和临床研究关注的热点很多,综合治疗方法有一定的改进,但治疗效果仍不能令人满意,临床上迫切需要提高早期诊断的水平,制订个体化的最佳治疗模式,这就要求检验、影像技术不断改进,合理使用各种治疗药物,加强重症监护和营养支持,采用内外科相结合的综合治…     

急性胰腺炎

急性胰腺炎通常分急性水肿性、出血性、坏死性、出血坏死性和化脓性胰腺炎。其病死率较高,特别是出血坏死性胰腺炎(重型)的病死率高达40％～70％。因此,及时诊治至关重要。 一、急性胰腺炎的诊断 水肿性胰腺炎可根据其症状体征和淀粉酶测定来诊断。但一些症状较轻或不明显的,就难以区别是急性还是慢性胰腺炎发作。急性胰腺炎时,可测得血和尿淀粉酶增高,血脂肪酶增高,淀粉酶同功酶P_3阳性,C-反应蛋白阳性。属酒精性者,则脂肪酶/淀粉酶≥0.5。若为重型胰腺炎,除以上诊断外,白细胞常15×10~9/L以上,血色正铁白蛋白阳性,血糖增高,血清转氨酶、乳酸脱氢酶、血尿素氮及肌酐等均可增高,血清脱氧核糖核酸酶-1(Date     

自身免疫性胰腺炎

自身免疫性胰腺炎 (AIP)是由自身免疫介导的一种慢性胰腺炎。AIP这一命名首先是由Sarles等[1] 提出 ,1995年Yoshida等[2 ] 对其定义加以补充、完善 ,其诊断标准是 1997年由Ito等[3 ] 明确提出 ,并且在 2 1世纪慢性胰腺炎分类系统中[4] AIP已作为慢性胰腺炎的一种独立分型单独存在。一、病因及发病机制2 0世纪 6 0年代人们认为AIP是必须与其他自身免疫性疾病相伴发生的 ,如Sj gren综合征、原发性胆汁性肝硬化、原发性硬化性胆管炎、炎症性肠病等。直至 1995年Yoshida等[2 ] 才提出无其他自身免疫疾病相伴的AIP概念。但二者的临床特征…     

慢性胰腺炎与胰腺癌的诊断

慢性胰腺炎（chronic pancreatitis，CP）与胰腺癌的诊断、治疗和基础研究一直存在很多难题，很少有患者得到早期诊断及有效治疗，且CP与胰腺癌的因果关系一直存有争议，缺乏有效的鉴别诊断方法。因此，对胰腺疾病的诊断研究多年来已成为全球性的热点。     

急性胰腺炎的诊断

腹痛加淀粉酶升高即为急性胰腺炎（Acute pancreatitis,AP）已流传了半个多世纪,但这一简单的公式显然再也不适合对AP发病机制与治疗日益发展的需要。根据临床特征,AP可分为轻症急性胰腺炎（mild acute pancreatitis,MAP）与重症急性胰腺炎（severe acute pancreatitis，SAP）。目前对急性胰腺炎除了要对是否为AP外，还必须尽可能做出AP的病因诊断及严重度判断。[第一段]     

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.     

Acute pancreatic necrosis in chronic alcoholic pancreatitis

Necrotic lesions are rarely observed in chronic pancreatitis, but its presence in a few patients has been misinterpreted in the diagnosis of acute pancreatitis. In this series, 12 patients (11.2%) of 107 operated for chronic alcoholic pancreatitis, presented with acute pancreatic necrosis associated with pancreatic fibrosis characteristic of chronic pancreatitis. Ten patients were treated by pancreatic debridement and drainage and two by distal pancreatic resections. Postoperative complications included five pancreatic fistulas and two pancreatic abscesses. Despite the severity of the pancreatic lesions which led to several complications, all the patients survived. The occurrence of pancreatic necrosis in patients with chronic pancreatitis is demonstrated.     

Acute pancreatitis

Acute pancreatitis is an inflammatory disease of the pancreas. Acute abdominal pain is the most common symptom, and increased concentrations of serum amylase and lipase confirm the diagnosis. Pancreatic injury is mild in 80% of patients, who recover without complications. The remaining patients have a severe disease with local and systemic complications. Gallstone migration into the common bile duct and alcohol abuse are the most frequent causes of pancreatitis in adults. About 15-25% of pancreatitis episodes are of unknown origin. Treatment of mild disease is supportive, but severe episodes need management by a multidisciplinary team including gastroenterologists, interventional radiologists, intensivists, and surgeons. Improved understanding of pathophysiology and better assessments of disease severity should ameliorate the management and outcome of this complex disease.     

Acute pancreatitis

Acute pancreatitis is an insidious inflammatory disease of the pancreas with its serious form leading to mortality in 20 to 30% of patients. Seemingly good clinical state at the onset of the disease is the cause of underestimation of resuscitation care in first hours of the disease. Whereas a basic prevention of the development of multiorgan dysfunction are an early re-establishing of the microcirculation and supranormal hemodynamic values. Making a differential diagnosis of the mild and the severe form of pancreatitis is possible after several days of intensive resuscitation care. Treatment of complications of acute pancreatitis, especially a long-term inflammatory process in retroperitoneum, require a patient and sometimes several month lasting intensive approach and interdisciplinary co-operation. Too early removal of drainage from the area of a necrotic gland or suppuration in retroperitoneum can be fatal to the patient.