Sekimoto Miho, Takada Tadahiro, Kawarada Yoshifumi, Hirata Koichi, Mayumi Toshihiko, Yoshida Masahiro, Hirota Masahiko, Kimura Yasutoshi, Takeda Kazunori, Isaji Shuji, Koizumi Masaru, Otsuki Makoto, Matsuno Seiki
Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto 606-8501, Japan.
J Hepatobiliary Pancreat Surg. 2006;13(1):10-24. doi: 10.1007/s00534-005-1047-3.
Acute pancreatitis is a common disease with an annual incidence of between 5 and 80 people per 100,000 of the population. The two major etiological factors responsible for acute pancreatitis are alcohol and cholelithiasis (gallstones). The proportion of patients with pancreatitis caused by alcohol or gallstones varies markedly in different countries and regions. The incidence of acute alcoholic pancreatitis is considered to be associated with high alcohol consumption. Although the incidence of alcoholic pancreatitis is much higher in men than in women, there is no difference in sexes in the risk involved after adjusting for alcohol intake. Other risk factors include endoscopic retrograde cholangiopancreatography, surgery, therapeutic drugs, HIV infection, hyperlipidemia, and biliary tract anomalies. Idiopathic acute pancreatitis is defined as acute pancreatitis in which the etiological factor cannot be specified. However, several studies have suggested that this entity includes cases caused by other specific disorders such as microlithiasis. Acute pancreatitis is a potentially fatal disease with an overall mortality of 2.1%-7.8%. The outcome of acute pancreatitis is determined by two factors that reflect the severity of the illness: organ failure and pancreatic necrosis. About half of the deaths in patients with acute pancreatitis occur within the first 1-2 weeks and are mainly attributable to multiple organ dysfunction syndrome (MODS). Depending on patient selection, necrotizing pancreatitis develops in approximately 10%-20% of patients and the mortality is high, ranging from 14% to 25% of these patients. Infected pancreatic necrosis develops in 30%-40% of patients with necrotizing pancreatitis and the incidence of MODS in such patients is high. The recurrence rate of acute pancreatitis is relatively high: almost half the patients with acute alcoholic pancreatitis experience a recurrence. When the gallstones are not treated, the risk of recurrence in gallstone pancreatitis ranges from 32% to 61%. After recovering from acute pancreatitis, about one-third to one-half of acute pancreatitis patients develop functional disorders, such as diabetes mellitus and fatty stool; the incidence of chronic pancreatitis after acute pancreatitis ranges from 3% to 13%. Nevertheless, many reports have shown that most patients who recover from acute pancreatitis regain good general health and return to their usual daily routine. Some authors have emphasized that endocrine function disorders are a common complication after severe acute pancreatitis has been treated by pancreatic resection.
急性胰腺炎是一种常见疾病，年发病率为每10万人中有5至80人。导致急性胰腺炎的两个主要病因是酒精和胆石症（胆结石）。酒精或胆结石所致胰腺炎患者的比例在不同国家和地区差异显著。急性酒精性胰腺炎的发病率被认为与高酒精摄入量有关。尽管酒精性胰腺炎的发病率男性远高于女性，但在调整酒精摄入量后，两性所涉及的风险并无差异。其他风险因素包括内镜逆行胰胆管造影术、手术、治疗药物、HIV感染、高脂血症和胆道异常。特发性急性胰腺炎被定义为病因无法明确的急性胰腺炎。然而，多项研究表明，这一类型包括由其他特定疾病如微结石症引起的病例。急性胰腺炎是一种潜在致命性疾病，总体死亡率为2.1% - 7.8%。急性胰腺炎的预后由反映疾病严重程度的两个因素决定：器官衰竭和胰腺坏死。急性胰腺炎患者约一半的死亡发生在最初1 - 2周内，主要归因于多器官功能障碍综合征（MODS）。根据患者选择情况，坏死性胰腺炎在约10% - 20%的患者中发生，且死亡率很高，在这些患者中为14%至25%。感染性胰腺坏死在30% - 40%的坏死性胰腺炎患者中发生，此类患者中MODS的发生率很高。急性胰腺炎的复发率相对较高：几乎一半的急性酒精性胰腺炎患者会复发。当胆结石未得到治疗时，胆石性胰腺炎的复发风险为32%至61%。急性胰腺炎恢复后，约三分之一至一半的急性胰腺炎患者会出现功能障碍，如糖尿病和脂肪泻；急性胰腺炎后慢性胰腺炎的发病率为3%至13%。然而，许多报告显示，大多数从急性胰腺炎中恢复的患者总体健康状况良好，恢复到日常日常生活。一些作者强调，内分泌功能障碍是重症急性胰腺炎经胰腺切除治疗后的常见并发症。
