Chronic Pancreatitis-Definition, Etiology, Investigation and Treatment
Chronic Pancreatitis-Definition, Etiology, Investigation and Treatment
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DOI：
10.3238/arztebl.2013.0387
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发表时间：
2013-05-31
影响因子：
7.7
通讯作者：
Moessner, Joachim
中科院分区：
文献类型：
--
作者：
Mayerle, Julia;Hoffmeister, Albrecht;Moessner, Joachim
背景资料：在德国，慢性胰腺炎的年发病率为每10万人中有23人，每年约有10，000人入院治疗。这种疾病使患者的预期寿命平均缩短23%。方法：系统检索相关文献19569篇，纳入本指南的文献485篇，其中随机对照试验（RCT）67篇。一个共识会议达成了协议，共156个定义和recommendations.Results：胰腺炎的遗传危险因素的识别，现在已经确立。诊断主要通过胰腺超声检查;如果结果不确定，可以进行进一步的研究，包括超声内镜和超声内镜辅助细针穿刺检查小病灶。计算机断层扫描和MRI/磁共振胰胆管造影是辅助诊断方法。内窥镜逆行胰胆管造影术现在几乎只用于治疗，而不是诊断。30%至60%的患者会出现慢性胰腺炎并发症，包括假性囊肿、胆管狭窄或药物难治性疼痛，这些都可以通过内窥镜或手术治疗。患有脂肪泻、病理性胰腺功能检查或临床吸收不良证据的患者应补充胰酶。胰头应切除，如果它包含炎性pseudotumer.Conclusion：慢性胰腺炎患者的管理需要密切的跨学科合作，因为它可以治疗医学和内窥镜以及手术。
Background: Chronic pancreatitis has an annual incidence of 23 per 100 000 population in Germany, where it accounts for about 10 000 hospital admissions per year. The disease shortens the life expectancy of its sufferers by an average of 23%. It most commonly affects men aged 20 to 40.Methods: A systematic search for pertinent literature retrieved 19 569 publications, 485 of which were considered in the creation of this guideline, including 67 randomized controlled trials (RCTs). A consensus conference reached agreement on a total of 156 definitions and recommendations.Results: The identification of genetic risk factors for pancreatitis is now well established. The diagnosis is made mainly with ultrasonography of the pancreas; if the findings are uncertain, further studies can be performed, including endosonography and endosonographically assisted fine-needle puncture for the examination of small foci of disease. Computed tomography and MRI/magnetic resonance cholangiopancreatography are supplementary diagnostic methods. Endoscopic retrograde cholangiopancreatography is now used almost exclusively for treatment, rather than for diagnosis. 30% to 60% of patients develop complications of chronic pancreatitis, including pseudocysts, bile-duct stenosis, or medically intractable pain, which can be treated with an endoscopic or surgical intervention. Patients with steatorrhea, a pathological pancreatic function test, or clinical evidence of malabsorption should be given pancreatin supplementation. The head of the pancreas should be resected if it contains an inflammatory pseudotumor.Conclusion: The management of patients with chronic pancreatitis requires close interdisciplinary collaboration, as it can be treated medically and endoscopically as well as surgically.