Chronic pancreatitis
Chronic pancreatitis
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DOI：
10.1038/nrdp.2017.60
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发表时间：
2017-09-07
影响因子：
81.5
通讯作者：
Neoptolemos, John P.
中科院分区：
文献类型：
--
作者：
Kleeff, Jorg;Whitcomb, David C.;Neoptolemos, John P.
慢性胰腺炎定义为具有遗传、环境和/或其他风险因素的个体中胰腺的病理性纤维炎症综合征，其对实质损伤或应激产生持续的病理反应。可能的原因包括毒性因素（如酒精或吸烟）、代谢异常、特发性机制、遗传学、自身免疫反应和阻塞性机制。慢性胰腺炎的病理生理学相当复杂，包括腺泡细胞损伤、腺泡应激反应、导管功能障碍、持续性或改变的炎症和/或神经免疫串扰，但这些机制尚未完全了解。慢性胰腺炎的特征在于胰腺的持续炎症，其导致由于萎缩和/或被纤维化组织替代而导致内分泌和外分泌室的进行性损失。功能性后果包括复发性或持续性腹痛、糖尿病（内分泌不足）和消化不良（外分泌不足）。诊断早期慢性胰腺炎具有挑战性，因为变化是微妙的，不明确的，并与其他疾病重叠。晚期的特征是胰腺实质的可变纤维化和钙化;胰管扩张、扭曲和狭窄;假性囊肿;胰内胆管狭窄;十二指肠狭窄;以及上级肠系膜、门静脉和/或脾静脉血栓形成。治疗方案包括医疗、放射、内窥镜和手术干预，但循证方法有限。本书重点介绍了在了解慢性胰腺炎及其并发症的病理生理学、表现、患病率和治疗方面取得的重大进展。
Chronic pancreatitis is defined as a pathological fibro-inflammatory syndrome of the pancreas in individuals with genetic, environmental and/or other risk factors who develop persistent pathological responses to parenchymal injury or stress. Potential causes can include toxic factors (such as alcohol or smoking), metabolic abnormalities, idiopathic mechanisms, genetics, autoimmune responses and obstructive mechanisms. The pathophysiology of chronic pancreatitis is fairly complex and includes acinar cell injury, acinar stress responses, duct dysfunction, persistent or altered inflammation, and/or neuro-immune crosstalk, but these mechanisms are not completely understood. Chronic pancreatitis is characterized by ongoing inflammation of the pancreas that results in progressive loss of the endocrine and exocrine compartment owing to atrophy and/or replacement with fibrotic tissue. Functional consequences include recurrent or constant abdominal pain, diabetes mellitus (endocrine insufficiency) and maldigestion (exocrine insufficiency). Diagnosing early-stage chronic pancreatitis is challenging as changes are subtle, ill-defined and overlap those of other disorders. Later stages are characterized by variable fibrosis and calcification of the pancreatic parenchyma; dilatation, distortion and stricturing of the pancreatic ducts; pseudocysts; intrapancreatic bile duct stricturing; narrowing of the duodenum; and superior mesenteric, portal and/or splenic vein thrombosis. Treatment options comprise medical, radiological, endoscopic and surgical interventions, but evidence-based approaches are limited. This Primer highlights the major progress that has been made in understanding the pathophysiology, presentation, prevalence and management of chronic pancreatitis and its complications.