Lordan Jeffrey T, Phillips Mary, Chun Joo-Young, Worthington Tim R, Menezes Neville N, Lightwood Robin, Hussain Fuad, Tibbs Christopher, Karanjia Nariman D
HPB Unit, Royal Surrey County Hospital, Guildford, Surrey, United Kingdom.
Pancreas. 2009 Aug;38(6):689-92. doi: 10.1097/MPA.0b013e3181a5edf8.
Chronic pancreatitis (CP) is common. It is associated with a substantial morbidity, including malnutrition, malabsorption, pseudocysts, metabolic disturbances, and intractable abdominal pain. Approximately 5% of patients with CP are refractory to nutritional support and opiate analgesia, making management challenging.Pancreatic rest can provide symptomatic relief. However, achieving simultaneous pancreatic rest and adequate nutritional support in these patients is difficult. We describe a technique for providing nutritional support and pancreatic rest in patients with intractable symptomatic CP.
Three patients with symptomatic CP refractory to standard treatment were included in the study. All 3 patients had masses associated with the pancreas. Symptom relief and adequate nutritional support were achieved by inserting a long-term nasojejunal (NJ) tube (Flocare Bengmark, Nutricia Clinical Care, United Kingdom) under ambulatory endoscopic guidance. Data were recorded prospectively.
Long-term NJ tube feeding achieved pancreatic rest and significant symptomatic relief while delivering adequate nutritional support. Pseudocyst size decreased substantially in 2 patients. The third patient was found to have pancreatic carcinoma after pancreaticoduodenectomy.
In patients with symptomatic CP refractory to standard nutritional support and opiate analgesia, long-term NJ tube feeding can be a cheap, well-tolerated, safe, and effective method of providing adequate nutritional support and substantially relieving intractable symptoms.
慢性胰腺炎（CP）很常见。它与严重的发病率相关，包括营养不良、吸收不良、假性囊肿、代谢紊乱和顽固性腹痛。约5%的CP患者对营养支持和阿片类镇痛药物无效，这使得治疗具有挑战性。胰腺休息可缓解症状。然而，在这些患者中同时实现胰腺休息和充足的营养支持很困难。我们描述了一种为有顽固性症状的CP患者提供营养支持和胰腺休息的技术。
研究纳入了3例对标准治疗无效的有症状CP患者。所有3例患者均有与胰腺相关的肿块。通过在门诊内镜引导下插入一根长期鼻空肠（NJ）管（Flocare Bengmark，纽迪希亚临床护理公司，英国）实现了症状缓解和充足的营养支持。数据进行前瞻性记录。
长期NJ管喂养在提供充足营养支持的同时实现了胰腺休息并显著缓解了症状。2例患者的假性囊肿大小大幅减小。第三例患者在胰十二指肠切除术后被发现患有胰腺癌。
对于对标准营养支持和阿片类镇痛药物无效的有症状CP患者，长期NJ管喂养可能是一种廉价、耐受性良好、安全且有效的方法，可提供充足的营养支持并显著缓解顽固性症状。
