美国慢性胰腺炎内镜和手术治疗的使用范围和效果。
Spectrum of use and effectiveness of endoscopic and surgical therapies for chronic pancreatitis in the United States.
机构信息
From the *Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH; †Department of Medicine, University of Pittsburgh, Pittsburgh, PA; ‡Digestive Disease Center, Medical University of South Carolina, Charleston, SC; §University of Michigan, Ann Arbor, MI; ∥Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA; ¶Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL; #Department of Medicine, Wake Forest University Medical Center, Winston-Salem, NC; **Department of Medicine, Indiana University Medical Center, Indianapolis, IN; ††Department of Internal Medicine, St Louis University School of Medicine, St Louis, MO; ‡‡North Mississippi Medical Center, Tupelo, MS; §§Monterey Gastroenterology, Monterey, CA; and ∥∥Department of Medicine, University of Florida, Gainesville, FL.
出版信息
Pancreas. 2014 May;43(4):539-43. doi: 10.1097/MPA.0000000000000122.
OBJECTIVE
This study aims to describe the frequency of use and reported effectiveness of endoscopic and surgical therapies in patients with chronic pancreatitis treated at US referral centers.
METHODS
Five hundred fifteen patients were enrolled prospectively in the North American Pancreatitis Study 2, where patients and treating physicians reported previous therapeutic interventions and their perceived effectiveness. We evaluated the frequency and effectiveness of endoscopic (biliary or pancreatic sphincterotomy, biliary or pancreatic stent placement) and surgical (pancreatic cyst removal, pancreatic drainage procedure, pancreatic resection, surgical sphincterotomy) therapies.
RESULTS
Biliary and/or pancreatic sphincterotomy (42%) were the most common endoscopic procedure (biliary stent, 14%; pancreatic stent, 36%; P < 0.001). Endoscopic procedures were equally effective (biliary sphincterotomy, 40.0%; biliary stent, 40.8%; pancreatic stent, 47.0%; P = 0.34). On multivariable analysis, the presence of abdominal pain (odds ratio, 1.82; 95% confidence interval, 1.15-2.88) predicted endoscopy, whereas exocrine insufficiency (odds ratio, 0.63; 95% confidence interval, 0.42-0.94) deterred endoscopy. Surgical therapies were attempted equally (cyst removal, 7%; drainage procedure, 10%; resection procedure, 12%) except for surgical sphincteroplasty (4%; P < 0.001). Surgical sphincteroplasty was the least effective (46%; P < 0.001) versus cyst removal (76% drainage [71%] and resection [73%]).
CONCLUSIONS
Although surgical therapies were performed less frequently than endoscopic therapies, they were more often reported to be effective.
目的
本研究旨在描述美国转诊中心治疗的慢性胰腺炎患者中内镜和手术治疗的使用频率和报告疗效。
方法
515 例患者前瞻性入组北美胰腺炎研究 2，患者和治疗医生报告了先前的治疗干预措施及其认为的疗效。我们评估了内镜（胆道或胰腺括约肌切开术、胆道或胰腺支架置入术）和手术（胰腺囊肿切除术、胰腺引流术、胰腺切除术、外科括约肌切开术）治疗的频率和疗效。
结果
胆道和/或胰腺括约肌切开术（42%）是最常见的内镜治疗方法（胆道支架，14%；胰腺支架，36%；P<0.001）。内镜治疗同样有效（胆道括约肌切开术，40.0%；胆道支架，40.8%；胰腺支架，47.0%；P=0.34）。多变量分析显示，腹痛存在（比值比，1.82；95%置信区间，1.15-2.88）预测内镜治疗，而外分泌功能不全（比值比，0.63；95%置信区间，0.42-0.94）则阻止内镜治疗。手术治疗同样尝试（囊肿切除术，7%；引流术，10%；切除术，12%），除了外科括约肌成形术（4%；P<0.001）。外科括约肌成形术的疗效最差（46%；P<0.001），与囊肿切除术（76%引流[71%]和切除术[73%]）相比。
结论
尽管手术治疗的频率低于内镜治疗，但它们被报告更有效。
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