慢性胰腺炎诊断与治疗研究进展
|
摘要
慢性胰腺炎是临床上较常见的慢性消化系统疾病,发病机制尚未明确,临床主要表现为反复发作性腹痛、消化不良、脂肪泻、血糖升高等,具有症状反复、迁延难愈的特点。结合多种影像学检查和胰腺内外分泌功能检测可提高慢性胰腺炎的确诊率。但对于早期慢性胰腺炎患者,目前仍难发现、难诊断。治疗策略上着重于缓解患者症状、控制疾病进展、改善胰腺功能和防治相关并发症,强调以个体化治疗为中心的多学科综合治疗。本文就慢性胰腺炎的疾病特点和近些年来的诊治进展做简要综述。
Chronic pancreatitis,as a chronic disease of digestive system,is commonly emerged and diagnosed. However, its pathogenesis remains unclear. The patients usually experience annoying symptoms such as recurrent abdominal pain,indigestion,fatty diarrhea,hyperglycemia,and so on.Patients with chronic pancreatitis tend to relapse easily and can′t be treated with satisfaction. Various kinds of imaging examinations,together with the measurement of pancreatic secretory function,can help the diagnosis of chronic pancreatitis. However,for patients with early chronic pancreatitis,it is still difficult to detect and diagnose. Therapeutic strategies mainly focus on the relief of clinical symptoms and avoiding deterioration. In the meantime,we are expected to improvethe pancreatic secretory function and prevent the relative complications. Furthermore,individualized multidisciplinary comprehensive treatmentis highlighted. Our present review gives a brief illustration on the disease characteristics and the developing views in the diagnosis and treatment of chronic pancreatitis in recent years.
Chronic pancreatitis,as a chronic disease of digestive system,is commonly emerged and diagnosed. However, its pathogenesis remains unclear. The patients usually experience annoying symptoms such as recurrent abdominal pain,indigestion,fatty diarrhea,hyperglycemia,and so on.Patients with chronic pancreatitis tend to relapse easily and can′t be treated with satisfaction. Various kinds of imaging examinations,together with the measurement of pancreatic secretory function,can help the diagnosis of chronic pancreatitis. However,for patients with early chronic pancreatitis,it is still difficult to detect and diagnose. Therapeutic strategies mainly focus on the relief of clinical symptoms and avoiding deterioration. In the meantime,we are expected to improvethe pancreatic secretory function and prevent the relative complications. Furthermore,individualized multidisciplinary comprehensive treatmentis highlighted. Our present review gives a brief illustration on the disease characteristics and the developing views in the diagnosis and treatment of chronic pancreatitis in recent years.
引文
[1]Whitcomb DC,Frulloni L,Garg P,et al.Chronic pancreatitis:An international draft consensus proposal for a new mechanistic definition[J].Pancreatology,2016,16(2):218-224.
[2]Majumder S,Chari ST.Chronic pancreatitis[J].Lancet,2016,387(10031):1957-1966.
[3]Lin Y,Tamakoshi A,Matsuno S,et al.Nationwide epidemiological survey of chronic pancreatitis in Japan[J].J Gastroenterol,2000,35(2):136-141.
[4]Lévy P,Domínguez-Mu?oz E,Imrie C,et al.Epidemiology of chronic pancreatitis:burden of the disease and consequences[J].United European Gastroenterol J,2014,2(5):345-354.
[5]Wang LW,Li ZS,Li SD,et al.Prevalence and clinical features of chronic pancreatitis in china:a retrospective multicenter analysis over 10 years[J].Pancreas,2009,38(3):248-254.
[6]CotéGA,Yadav D,Slivka A,et al.Alcohol and smoking as risk factors in an epidemiology study of patients with chronic pancreatitis[J].Clin Gastroenterol Hepatol,2011,9:266-273.
[7]Conwell DL,Banks PA,Sandhu BS,et al.Validation of demographics,etiology,and risk factors for chronic pancreatitis in the USA:A report of the North American Pancreas Study(NAPS)Group[J].Dig Dis Sci,2017,62(8):2133-2140.
[8]中华医学会外科学分会胰腺外科学组.慢性胰腺炎诊治指南_2014[J].中华外科杂志,2015,53(4):241-246.
[9]Shimosegawa T,Kataoka K,Kamisawa T,et al.The revised Japanese clinical diagnostic criteria for chronic pancreatitis[J].J Gastroenterol,2010,45(6):584-591.
[10]Ito T,Ishiguro H,Ohara H,et al.Evidence-based clinical practice guidelines for chronic pancreatitis[J].J Gastroenterol,2016,51(2):85-92.
[11]Hao L,Zeng XP,Xin L,et al.Incidence of and risk factors for pancreatic cancer in chronic pancreatitis:A cohort of 1656patients[J].Dig Liver Dis,2017,49(11):1249-1256.
[12]Conwell DL,Lee LS,Yadav D,et al.American Pancreatic Association Practice Guidelines in Chronic Pancreatitis:evidence-based report on diagnostic guidelines[J].Pancreas,2014,43(8):1143-1162.
[13]Sheel ARG,Baron RD,Sarantitis I,et al.The diagnostic value of Rosemont and Japanese diagnostic criteria for‘indeterminate′,‘suggestive′,‘possible′and‘early′chronic pancreatitis[J].Pancreatology,2018,18(7):774-784.
[14]Stevens T,Dumot JA,Zuccaro G Jr,et al.Evaluation of ductcell and acinar-cell function and endosonographic abnormalities in patients with suspected chronic pancreatitis[J].Clin Gastroenterol Hepatol,2009,7(1):114-119.
[15]胡良皞,李兆申.慢性胰腺炎胰管结石的微创治疗[J].肝胆外科杂志,2014,22(1):9-11.
[16]Dumonceau JM,Delhaye M,Tringali A,et al.Endoscopic treatment of chronic pancreatitis:European Society of Gastrointestinal Endoscopy(ESGE)Clinical Guideline[J].Endoscopy,2012,44(8):784-800.
[17]Ahmed Ali U,Issa Y,Bruno MJ,et al.Early surgery versus optimal current step-up practice for chronic pancreatitis(ES-CAPE):design and rationale of a randomized trial[J].BMCGastroenterol,2013,13:49.
[18]Issa Y,Bruno MJ,Bakker OJ,et al.Treatment options for chronic pancreatitis[J].Nat Rev Gastroenterol Hepatol,2014,11(9):556-564.
[19]van der Gaag NA,van Gulik TM,Busch OR,et al.Functional and medical outcomes after tailored surgery for pain due to chronic pancreatitis[J].Ann Surg,2012,255(4):763-770.
[20]Kleeff J,St??C,Mayerle J,et al.Evidence-based surgical treatments for chronic pancreatitis[J].Dtsch Arztebl Int,2016,113(29-30):489-496.
[21]Diener MK,Rahbari NN,FischerL,et al.Duodenum-preserving pancreatic head resection versus pancreatoduodenectomy for surgical treatment of chronic pancreatitis:a systematic review and meta-analysis[J].Ann Surg,2008,247(6):950-961.
[22]Zhao Y,Zhang J,Lan Z,et al.Duodenum-preserving resection of the pancreatic head versus pancreaticoduodenectomy for treatment of chronic pancreatitis with enlargement of the pancreatic head:systematic review and meta-analysis[J].Biomed Res Int,2017:3565438.
[23]Yekebas EF,Bogoevski D,Honarpisheh H,et al.Long-term follow-up in small duct chronic pancreatitis:A plea for extended drainage by“V-shaped excision”of the anterior aspect of the pancreas[J].Ann Surg,2006,244(6):940-946.
[24]Behrns KE.Local resection of the pancreatitic head for pancreatic pseudocysts[J].J Gastrointest Surg,2008,12(12):2227-2230.
[25]Ahmed Ali U,Nieuwenhuijs VB,van Eijck CH,et al.Clinical outcome in relation to timing of surgery in chronic pancreatitis:a nomogram to predict pain relief[J].Arch Surg,2012,147(10):925-932.
[26]Ahmed Ali U,Pahlplatz JM,Nealon WH,et al.Endoscopic or surgical intervention for painful obstructive chronic pancreatitis[J].Cochrane Database Syst Rev,2015,3:CD007884.
[27]Yang CJ,Bliss LA,Freedman SD,et al.Surgery for chronic pancreatitis:the role of early surgery in pain management[J].Pancreas,2015,44(5):819-823.
[2]Majumder S,Chari ST.Chronic pancreatitis[J].Lancet,2016,387(10031):1957-1966.
[3]Lin Y,Tamakoshi A,Matsuno S,et al.Nationwide epidemiological survey of chronic pancreatitis in Japan[J].J Gastroenterol,2000,35(2):136-141.
[4]Lévy P,Domínguez-Mu?oz E,Imrie C,et al.Epidemiology of chronic pancreatitis:burden of the disease and consequences[J].United European Gastroenterol J,2014,2(5):345-354.
[5]Wang LW,Li ZS,Li SD,et al.Prevalence and clinical features of chronic pancreatitis in china:a retrospective multicenter analysis over 10 years[J].Pancreas,2009,38(3):248-254.
[6]CotéGA,Yadav D,Slivka A,et al.Alcohol and smoking as risk factors in an epidemiology study of patients with chronic pancreatitis[J].Clin Gastroenterol Hepatol,2011,9:266-273.
[7]Conwell DL,Banks PA,Sandhu BS,et al.Validation of demographics,etiology,and risk factors for chronic pancreatitis in the USA:A report of the North American Pancreas Study(NAPS)Group[J].Dig Dis Sci,2017,62(8):2133-2140.
[8]中华医学会外科学分会胰腺外科学组.慢性胰腺炎诊治指南_2014[J].中华外科杂志,2015,53(4):241-246.
[9]Shimosegawa T,Kataoka K,Kamisawa T,et al.The revised Japanese clinical diagnostic criteria for chronic pancreatitis[J].J Gastroenterol,2010,45(6):584-591.
[10]Ito T,Ishiguro H,Ohara H,et al.Evidence-based clinical practice guidelines for chronic pancreatitis[J].J Gastroenterol,2016,51(2):85-92.
[11]Hao L,Zeng XP,Xin L,et al.Incidence of and risk factors for pancreatic cancer in chronic pancreatitis:A cohort of 1656patients[J].Dig Liver Dis,2017,49(11):1249-1256.
[12]Conwell DL,Lee LS,Yadav D,et al.American Pancreatic Association Practice Guidelines in Chronic Pancreatitis:evidence-based report on diagnostic guidelines[J].Pancreas,2014,43(8):1143-1162.
[13]Sheel ARG,Baron RD,Sarantitis I,et al.The diagnostic value of Rosemont and Japanese diagnostic criteria for‘indeterminate′,‘suggestive′,‘possible′and‘early′chronic pancreatitis[J].Pancreatology,2018,18(7):774-784.
[14]Stevens T,Dumot JA,Zuccaro G Jr,et al.Evaluation of ductcell and acinar-cell function and endosonographic abnormalities in patients with suspected chronic pancreatitis[J].Clin Gastroenterol Hepatol,2009,7(1):114-119.
[15]胡良皞,李兆申.慢性胰腺炎胰管结石的微创治疗[J].肝胆外科杂志,2014,22(1):9-11.
[16]Dumonceau JM,Delhaye M,Tringali A,et al.Endoscopic treatment of chronic pancreatitis:European Society of Gastrointestinal Endoscopy(ESGE)Clinical Guideline[J].Endoscopy,2012,44(8):784-800.
[17]Ahmed Ali U,Issa Y,Bruno MJ,et al.Early surgery versus optimal current step-up practice for chronic pancreatitis(ES-CAPE):design and rationale of a randomized trial[J].BMCGastroenterol,2013,13:49.
[18]Issa Y,Bruno MJ,Bakker OJ,et al.Treatment options for chronic pancreatitis[J].Nat Rev Gastroenterol Hepatol,2014,11(9):556-564.
[19]van der Gaag NA,van Gulik TM,Busch OR,et al.Functional and medical outcomes after tailored surgery for pain due to chronic pancreatitis[J].Ann Surg,2012,255(4):763-770.
[20]Kleeff J,St??C,Mayerle J,et al.Evidence-based surgical treatments for chronic pancreatitis[J].Dtsch Arztebl Int,2016,113(29-30):489-496.
[21]Diener MK,Rahbari NN,FischerL,et al.Duodenum-preserving pancreatic head resection versus pancreatoduodenectomy for surgical treatment of chronic pancreatitis:a systematic review and meta-analysis[J].Ann Surg,2008,247(6):950-961.
[22]Zhao Y,Zhang J,Lan Z,et al.Duodenum-preserving resection of the pancreatic head versus pancreaticoduodenectomy for treatment of chronic pancreatitis with enlargement of the pancreatic head:systematic review and meta-analysis[J].Biomed Res Int,2017:3565438.
[23]Yekebas EF,Bogoevski D,Honarpisheh H,et al.Long-term follow-up in small duct chronic pancreatitis:A plea for extended drainage by“V-shaped excision”of the anterior aspect of the pancreas[J].Ann Surg,2006,244(6):940-946.
[24]Behrns KE.Local resection of the pancreatitic head for pancreatic pseudocysts[J].J Gastrointest Surg,2008,12(12):2227-2230.
[25]Ahmed Ali U,Nieuwenhuijs VB,van Eijck CH,et al.Clinical outcome in relation to timing of surgery in chronic pancreatitis:a nomogram to predict pain relief[J].Arch Surg,2012,147(10):925-932.
[26]Ahmed Ali U,Pahlplatz JM,Nealon WH,et al.Endoscopic or surgical intervention for painful obstructive chronic pancreatitis[J].Cochrane Database Syst Rev,2015,3:CD007884.
[27]Yang CJ,Bliss LA,Freedman SD,et al.Surgery for chronic pancreatitis:the role of early surgery in pain management[J].Pancreas,2015,44(5):819-823.