慢性胰腺炎合并胰管结石的诊断和治疗

Diagnosis treatment of chronic pancreatitis combinded with pancreatic duct stones

慢性胰腺炎是由于多种原因(酗酒、胆道系统疾病等)造成的胰腺组织结构和功能持续性损害,常合并胰管结石。疼痛是其最主要症状,同时常伴有消化不良、脂肪泻、糖尿病等并发症。结合多种影像学检查方法如B超、CT、ERCP和磁共振胰胆管造影(MRCP)等能明显提高慢性胰腺炎合并胰管结石的确诊率。慢性胰腺炎合并胰管结石应予以积极治疗,以控制症状、改善胰腺功能和治疗并发症为重点,强调以个体化治疗为原则的综合治疗。在体外震波碎石及内镜取石不彻底而症状不能控制或结石复发者应尽早手术治疗,根据结石分布范围选择相应的治疗方式,彻底去除病灶,取净结石,解除胰、胆管梗阻,充分引流胰液,同时注意尽量保存胰腺组织功能,可明显改善病人生存质量。

Chronic pancreatitis is a progressive fibroinflammatory disease with sustained damage of structure and function of pancreatic tissue, which resuhs from a complex mix of causes （eg, alcohol, Biliary diseases）, and often exists with intraductal calculi. Pain in the form of recurrent attacks of panereatitis or constant ant/disabling pain is usually the main symptom. Steatorrhoea, diabetes, local complications associated with the disease are additional therapeutic challenges. Combined with a variety of imaging methods such as BUS, CT, ERCP and MRCP, etc. can significantly improve the diagnosis of chronic pancreatitis with panereatie duct stone. Chronic pancreatitis with pancreatic duet stones should be actively treated, of which the focus is to control symptoms, improve function and treatment of eomplications with individual therapy. The appropriate surgery should be perfornled as soon as possible according to distribution of stone when the stone removal is not complete or recrudescent after extracorporeal shock wave lithotripsy and endoscopic. completely removing the lesion, taking out all the stones, removing the panereas and bile duct obstruction, fully drainage of pancreatic juice and trying to save the panereatie tissues are the goal of the surgery, which ean significantly improve quality of life of patients.