慢性胰腺炎诊断与治疗临床研究(附262例分析)

为探讨慢性胰腺炎（CP）的诊断和治疗措施，回顾分析了1993年1月-2001年5月本院收治的CP262例。CP中68.3%为胆源性胰腺炎，长期饮酒者占21.4%，多数为少量饮酒，与国外以酒精性胰腺炎为主不同；此外，29.8%的患者有急性胰腺炎病史，13%为胰腺分裂症。临床症状以上腹部轻度疼痛为主，伴有食欲减退等上消化道症状。影像学检查中腹部B超、CT、MRCP、ERCP、EUS有助于本病的诊断。132例患者行内科保守治疗；78例行内镜下胰管括约肌切开、胰管取石及胰管支架置入引流治疗；52例行外科手术治疗，包括胰肠吻合术、胰腺切除、胰腺假性囊肿引流等。随访238例，疗效良好。提示我国大多数CP与胆道疾病有关，临床症状缺乏特异性，影像学检查有助于早期诊断。对于轻、中度腹痛而无合并症者可行内科保守治疗；内镜治疗对CP兼有诊断和治疗双重作用，有较好的疗效；对顽固性疼痛、伴有严重合并症或肿瘤难以排除者应采取积极的手术治疗。

DIAGNOSIS AND TREATMENT OF CHRONIC PANCREATITIS: A CLINICAL STUDY OF 262 CASES

To evaluate the possible method for the diagnosis and treatment of chronic pancreatitis (CP), two hundred and sixty two cases of CP from January 1993 to May 2001 were involved and analyzed retrospectively. Etiologic factors in this group included 68 3% of biliary disorders, 21 4% of alcoholic intake, 29 8% of acute pancreatitis (AP) episode history, and 13% of pancreatic divisum (PD). The major symptom of CP was discomfort or pain over the upper abdominal. Ultrasonography, CT, MRCP, ERCP, and EUS were useful for the diagnosis of CP. One hundred and thirty two patients were treated conservatively, and 78 patients were treated with endoscopy, while only 52 patients were treated with operation. The short term remission rates of symptoms were satisfactory in all cases, and long term ones in 238 patients. Biliary disorders were the most common etiology for CP in this group.The results suggest that the clinical symptoms of CP are not specific and choices of image tools for diagnosis of CP are important. Medication can be used in mild CP patients, but in patients ac companied with sever complications and stubborn abdominal pain surgical operation should be carried out. Furthermore, endoscopy is a useful tool not only for the diagnosis of CP but also for its treatment.