慢性胰腺炎的诊断和治疗(附37例分析)

Diagnosis and treatment of chronic pancreatitis:a report of 37 cases

目的 :探讨慢性胰腺炎 (chronic pancreatitis,CP)的诊断和治疗。方法 :回顾性分析 1993年 1月～ 1999年 12月间收治的 37例 CP。结果 :我国 CP病因与国外以长期嗜酒为主有所不同 ,而与胆道疾病关系最为密切。其主要症状是反复上腹痛向背部放射 ,易误诊为消化性溃疡、胆道病变、肠炎等。 B超、CT、ERCP和 MRCP等影像检查有助于早期确诊。 15例症状轻者行保守治疗 ,2 2例症状严重或伴合并症者分别行胆囊切除、胆总管切开 T管引流、胆肠吻合、Oddi括约肌成形、胰肠吻合、胰腺假性囊肿引流或胰腺切除等手术。全部病例近期疗效满意 ,31例获 1/ 2～ 6年的随访 ,其中 2 9例 (93.5 % )疗效良好。结论 :提高对本病的认识 ,结合影像检查是早期诊断 CP的关键。轻中度腹痛及无合并症者可行保守治疗 ,顽固性疼痛或伴合并症者根据不同的胰腺病理改变选用相应的手术治疗。

Objective: To discuss the diagnosis and treatment of chronic pancreatitis (CP) . Methods: 37 cases of CP from January 1993 to December 1999 were analyzed retrospectively.Results: Biliary disorders are the most important etiology for CP in our country while in western countries alcoholic intemperance is mostly seen. Relapsing upper abdominal pain with dorsal radiation is the cardinal symptom of CP, and it may mislead the diagnosis to peptic ulcer as well as biliary disorders or enteritis, et al. Using BUS, CT, ERCP and MRCP, we usually can get an early diagnosis definitely. 15 patients with milder symptoms were treated conservatively while 22 cases with severer symptoms or with complications respectively underwent cholecystectomy, choledochostomy, choledochojejunostomy, Oddi sphincteroplasty, pancreaticojejunostomy, drainage of pancreatic pseudocyst or pancreatectomy. The results of all patients in the near future were satisfactory, and the results of 29 (93.5%) of 31 cases were also good after the follow up for 1/2～6 years.Conclusion: A thorough understanding of the pathogenic mechanism of CP and the correct use of image tools are the two important aspects in diagnostic practice. Patients with mild or moderate pain and without any complications can be treated conservatively. But those with intractable pain or complications should be operated. The procedures should be properly selected according to different pathologic changes within the pancreas.