Department of Gastroenterology, Second Teaching Hospital, Fujita Health University School of Medicine, Nakagawa-ku, Nagoya, Japan.
J Gastroenterol Hepatol. 2013 Dec;28 Suppl 4:108-12. doi: 10.1111/jgh.12250.
Chronic pancreatitis is progressive and irreversible, leading to digestive and absorptive disorders by destruction of the exocrine pancreas and to diabetes mellitus by destruction of the endocrine pancreas. When complications such as pancreatolithiasis and pseudocyst occur, elevated pancreatic ductal pressure exacerbates pain and induces other complications, worsening the patient's general condition. Combined treatment with extracorporeal shock-wave lithotripsy and endoscopic lithotripsy is a useful, minimally invasive, first-line treatment approach that can preserve pancreatic exocrine function. Pancreatic duct stenosis elevates intraductal pressure and favor both pancreatolithiasis and pseudocyst formation, making effective treatment vitally important. Endoscopic treatment of benign pancreatic duct stenosis stenting frequently decreases pain in chronic pancreatitis. Importantly, stenosis of the main pancreatic duct increases risk of stone recurrence after treatment of pancreatolithiasis. Recently, good results were reported in treating pancreatic duct stricture with a fully covered self-expandable metallic stent, which shows promise for preventing stone recurrence after lithotripsy in patients with pancreatic stricture. Chronic pancreatitis has many complications including pancreatic carcinoma, pancreatic atrophy, and loss of exocrine and endocrine function, as well as frequent recurrence of stones after treatment of pancreatolithiasis. As early treatment of chronic pancreatitis is essential, the new concept of early chronic pancreatitis, including characteristics findings in endoscopic ultrasonograms, is presented.
慢性胰腺炎是进行性和不可逆转的，通过破坏外分泌胰腺导致消化和吸收障碍，并通过破坏内分泌胰腺导致糖尿病。当发生胰石症和假性囊肿等并发症时，胰管内压升高会加剧疼痛并引发其他并发症，从而使患者的一般状况恶化。体外冲击波碎石术和内镜下碎石术联合治疗是一种有用的、微创的一线治疗方法，可以保留胰腺外分泌功能。胰管狭窄会升高管内压力，有利于胰石症和假性囊肿的形成，因此有效的治疗至关重要。内镜治疗良性胰管狭窄支架置入术常可缓解慢性胰腺炎的疼痛。重要的是，主胰管狭窄会增加胰石症治疗后结石复发的风险。最近，使用全覆膜自膨式金属支架治疗胰管狭窄取得了良好的效果，这为预防胰管狭窄患者碎石后结石复发提供了希望。慢性胰腺炎有许多并发症，包括胰腺癌、胰腺萎缩、外分泌和内分泌功能丧失，以及胰石症治疗后结石频繁复发。由于早期治疗慢性胰腺炎至关重要，因此提出了早期慢性胰腺炎的新概念，包括内镜超声检查中的特征性发现。
