2180例慢性胰腺炎临床特征及治疗模式变迁分析

Clinical features and therapeutic changes of chronic pancreatitis （CP） ： 2180 cases

目的探讨长海医院近20年收治慢性胰腺炎患者的临床特征和治疗模式变迁。方法回顾性分析长海医院1995年至2012年收治的2180例慢性胰腺炎的病因、临床特征、合并症以及治疗方式等。结果2180例患者中，男女比例为2．24：1，平均年龄（46．24±15．99）岁。病因学方面，酒精性740例（33．95％），特发性1336例（61．28％），先天性胰腺发育异常88例（4．04％），遗传性16例（0．73％）。合并症方面，535例（24．54％）伴有糖尿病，322例（14．77％）伴有脂肪泻，108例（4．95％）伴有胆管狭窄。1440例患者（66．06％）接受了内镜治疗，490例（22．48％）接受了体外震波碎石治疗，468例患者（21．47％）接受了外科手术治疗。内镜和外科手术治疗的比例由2000年之前的0．73：1上升到2012年的17．6：1。内镜治疗组和外科手术组并发症发生率分别为4．25％和3．42％（P〉0．05）。结论研究揭示了我国慢性胰腺炎的病因、合并症和治疗现状，内镜为主的微创系列治疗已经取代了部分外科手术，成为慢性胰腺炎的一线治疗。

Objective To evaluate the clinical features of chronic pancreatitis （CP） patients admitted to Changhai Hospital in recent 20 years and some changes in treatment. Methods Data of 2180 CP patients admitted from 1995 to 2012 were retrospectively analyzed for the etiology, clinical symptoms, therapies and complication rates. Results Males to females ratio was 2. 24 ： 1, mean age 46.24 ± 15.99 years old. In terms of etiology, there were 740 cases of alcoholic CP （33.95%）, 1336 cases of idiopathic CP （61.28%）, 88 congenital pancreatic abnormalities （4. 04% ） and 16 hereditary CP （0. 73% ）. In the re- spect of complications, 535 patients （24. 54% ） were complicated with diabetes, 322 （ 14. 77% ） with steatorrhea and 108 （4. 95% ） with biliary strictures. In therapy, 1440 patients （66.06%） were treated by endoscopy, 490 patients underwent ESWL, and 468 patients （21.47%） accepted surgery. The radio of endoscopic therapy to surgical therapy increased from 0. 73 ： 1 in 2000 to 17. 6 ： 1 in 2012. The postoperative complication rates of endotherapy, ESWL and surgery were 4. 25%, 4. 18% and 3.42% respectively, which had no statistically significant difference （P 〉 0. 05）. Conclusion The mini-invasive endotherapy has partly replaced pancreatic surgery and become the first therapy for CP patients.