Hackert Thilo, Schütte Kerstin, Malfertheiner Peter
Department of General Surgery, University of Heidelberg, Germany.
Department of Gastroenterology, Hepatology and Infectious Diseases, Otto von Guericke University of Magdeburg, Germany.
Viszeralmedizin. 2014 Jun;30(3):190-7. doi: 10.1159/000363778.
The pancreas has a central function in digestion and glucose homeostasis. With regard to the exocrine function, which is responsible for the digestion and absorption of nutrients and vitamins, the most important disturbances of these physiological processes are based on deficiencies in enzyme production and secretion, either due to impaired excretion caused by obstruction of the pancreatic duct or due to loss of pancreatic tissue. Both conditions result in maldigestion, malabsorption, and malnutrition.
Systematic literature review.
Symptoms associated with pancreatic exocrine failure are gastrointestinal discomfort, steatorrhea, and weight loss. Pancreatic exocrine insufficiency caused by ductal obstruction occurs in chronic pancreatitis or with neoplasia of the pancreatic head. Loss of functional parenchyma can be caused either by chronic pancreatitis resulting in fibrotic replacement of the destroyed parenchyma or by a postoperative state of pancreatic resection.
In patients with chronic pancreatitis, a stage-adapted and timely therapy including conservative as well as surgical measures is essential to prevent functional deterioration and to preserve residual function. In the case of pancreatic resection for chronic pancreatitis, this can be achieved with modern organ-sparing surgery such as the duodenum-preserving pancreatic head resection. In patients requiring more extended pancreatic resections and even total duodenopancreatectomy, regardless of the underlying indication, adequate enzyme replacement and monitoring of the nutritional status is critical to prevent impairment of quality of life as well as detrimental malnutrition in the long term.
胰腺在消化和葡萄糖稳态中起核心作用。就负责营养物质和维生素消化与吸收的外分泌功能而言，这些生理过程最重要的紊乱是基于酶产生和分泌的缺陷，这要么是由于胰管阻塞导致的排泄受损，要么是由于胰腺组织的丧失。这两种情况都会导致消化不良、吸收不良和营养不良。
系统文献综述。
与胰腺外分泌功能不全相关的症状有胃肠道不适、脂肪泻和体重减轻。由导管阻塞引起的胰腺外分泌功能不全发生在慢性胰腺炎或胰头肿瘤时。功能性实质的丧失可由导致被破坏的实质发生纤维化替代的慢性胰腺炎或胰腺切除术后状态引起。
对于慢性胰腺炎患者，包括保守和手术措施在内的根据分期调整且及时的治疗对于预防功能恶化和保留残余功能至关重要。在因慢性胰腺炎进行胰腺切除的情况下，这可以通过现代保留器官手术如保留十二指肠的胰头切除术来实现。在需要更广泛的胰腺切除甚至全胰十二指肠切除术的患者中，无论潜在病因如何，充分的酶替代和营养状况监测对于预防生活质量受损以及长期有害的营养不良至关重要。
