Keller Jutta, Andresen Viola, Rosien Ulrich, Layer Peter
Israelitic Hospital, Orchideenstieg 14, D-22297 Hamburg, Germany.
Best Pract Res Clin Gastroenterol. 2007;21(3):519-33. doi: 10.1016/j.bpg.2007.01.004.
Abdominal complaints in combination with slightly elevated serum pancreatic enzymes represent a classical clinical challenge. These symptoms may be due to coincidental unrelated harmless disorders, benign pancreatic alterations which are fairly easily treatable such as mild acute pancreatitis or uncomplicated chronic pancreatitis. However, serious, often insidious diseases such as pancreatic tumours may also present with this constellation as their first signs. Diagnostic procedures need to be stratified according to acuteness and severity of symptoms. While patients with acute onset of symptoms and severe complaints need immediate and combined laboratory and imaging investigations to allow adequate therapy, chronic and mild complaints usually justify a stepwise diagnostic approach consecutively using abdominal ultrasound, CT/MRI and endoscopic ultrasound as imaging procedures and reserving ERCP for cases which remain unclear or in which interventional therapy is needed. Diagnosis and follow-up are often particularly demanding in patients with cystic tumours of the pancreas. In chronic pancreatitis patients pain therapy and adequate control of pancreatic exocrine insufficiency may pose major problems. Patients with refractory pain may ultimately require surgical intervention. Another important indication for surgery in chronic pancreatitis is suspicion of cancer that cannot be ruled out by dedicated diagnostic procedures. This also applies to cystic tumours of the pancreas, which have a high risk of malignant transformation or may even already represent pancreatic cancer at the time of diagnosis.
腹部不适伴血清胰酶轻度升高是典型的临床挑战。这些症状可能是由偶然的无关无害疾病、良性胰腺改变引起的，这些改变相当容易治疗，如轻度急性胰腺炎或非复杂性慢性胰腺炎。然而，严重的、通常隐匿的疾病，如胰腺肿瘤，也可能以这种症状组合作为首发体征。诊断程序需要根据症状的急性程度和严重程度进行分层。对于症状急性发作且主诉严重的患者，需要立即进行实验室和影像学联合检查，以便进行适当治疗；而慢性和轻度主诉通常采用逐步诊断方法，依次使用腹部超声、CT/MRI和内镜超声作为影像学检查手段，对于仍不明确或需要介入治疗的病例保留ERCP检查。胰腺囊性肿瘤患者的诊断和随访通常特别具有挑战性。在慢性胰腺炎患者中，疼痛治疗和胰腺外分泌功能不全的充分控制可能会带来重大问题。难治性疼痛患者最终可能需要手术干预。慢性胰腺炎手术的另一个重要指征是怀疑癌症，而专门的诊断程序无法排除这种怀疑。这也适用于胰腺囊性肿瘤，其具有高恶性转化风险，甚至在诊断时可能已为胰腺癌。
