慢性胰腺炎的治疗策略:内镜治疗与外科干预

慢性胰腺炎是由多种病因导致的胰腺慢性炎症性和纤维化病变,其基本治疗原则为去除病因、缓解症状、改善胰腺分泌功能不足及防治并发症等。目前,对于慢性胰腺炎治疗策略的探讨日趋增多,创伤递进式策略与早期外科手术干预是共性治疗理念。临床实践中,对于出现胰腺假性囊肿、胰管结石、胆管狭窄等并发症,内镜干预可作为优选治疗方式;无胰头部病变的主胰管扩张,可首选Partington术;合并胰头部病变,可行Beger术或Frey术;无主胰管扩张,应根据具体病变部位行胰腺切除术;全胰炎性病变或多发部位病变,可行全胰腺切除术。外科医师在诸多手术方式的选择中,应遵循个体化与多学科化的整体治疗理念与策略,尤其对于干预指征、时机及方式的掌控。笔者综合分析国内外研究进展,阐述慢性胰腺炎的内镜治疗与外科干预策略,以期进一步优化慢性胰腺炎病人的整体疗效。

The treatment strategies for chronic pancreatitis:endoscopic treatment or surgical intervention

Chronic pancreatitis(CP)is a chronic inflammatory and fibrotic disease of the pancreas caused by a variety of causes.The basic treatment principle of CP is to remove the etiology,control the symptoms,improve the pancreatic secretory function and prevent the complications.At present,more and more studies have been conducted on CP treatment strategies.The step-up approach and the surgery first approach are both effective strategies for CP treatment.In clinical practice,endoscopic intervention can be the preferred treatment for pancreatic pseudocyst,pancreatic duct stone,and biliary stenosis.Partington operation is the first choice for dilated main pancreatic duct patients without pancreatic head lesion.Patients with pancreatic head lesions should be intervened with the Beger or Frey operation.For patients without main pancreatic duct dilatation,pancreatectomy should be performed according to the specific lesion location.The total pancreatectomy is advisable for patients with total pancreatic inflammatory disease or multiple lesions of pancreas.Surgeons should follow the individualized and multidisciplinary treatment concepts and strategies in choosing surgical procedures,especially for the control of surgical indications,timing and methods.The authors comprehensively analyze the research progress at home and abroad,elaborate the endoscopic treatment and surgical intervention strategies of CP in order to further optimize the overall efficacy of CP.