Parekh Dilip, Natarajan Sathima
Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, Los Angeles, CA 90033 USA.
Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, Los Angeles, CA 90033 USA ; Department of Pathology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA USA.
Indian J Surg. 2015 Oct;77(5):453-69. doi: 10.1007/s12262-015-1362-0. Epub 2015 Oct 22.
Advances over the past decade have indicated that a complex interplay between environmental factors, genetic predisposition, alcohol abuse, and smoking lead towards the development of chronic pancreatitis. Chronic pancreatitis is a complex disorder that causes significant and chronic incapacity in patients and a substantial burden on the society. Major advances have been made in the etiology and pathogenesis of this disease and the role of genetic predisposition is increasingly coming to the fore. Advances in noninvasive diagnostic modalities now allow for better diagnosis of chronic pancreatitis at an early stage of the disease. The impact of these advances on surgical treatment is beginning to emerge, for example, patients with certain genetic predispositions may be better treated with total pancreatectomy versus lesser procedures. Considerable controversy remains with respect to the surgical management of chronic pancreatitis. Modern understanding of the neurobiology of pain in chronic pancreatitis suggests that a window of opportunity exists for effective treatment of the intractable pain after which central sensitization can lead to an irreversible pain syndrome in patients with chronic pancreatitis. Effective surgical procedures exist for chronic pancreatitis; however, the timing of surgery is unclear. For optimal treatment of patients with chronic pancreatitis, close collaboration between a multidisciplinary team including gastroenterologists, surgeons, and pain management physicians is needed.
过去十年的进展表明，环境因素、遗传易感性、酗酒和吸烟之间的复杂相互作用会导致慢性胰腺炎的发生。慢性胰腺炎是一种复杂的疾病，会给患者带来严重且长期的身体机能丧失，并给社会造成沉重负担。在该疾病的病因和发病机制方面已取得重大进展，遗传易感性的作用日益凸显。无创诊断方法的进步现在能够在疾病早期更好地诊断慢性胰腺炎。这些进展对手术治疗的影响正开始显现，例如，具有某些遗传易感性的患者接受全胰切除术可能比接受较小手术的治疗效果更好。关于慢性胰腺炎的手术管理仍存在相当大的争议。对慢性胰腺炎疼痛神经生物学的现代理解表明，存在有效治疗顽固性疼痛的机会窗口，在此之后，中枢敏化可能导致慢性胰腺炎患者出现不可逆的疼痛综合征。存在针对慢性胰腺炎的有效手术方法；然而，手术时机尚不清楚。为了对慢性胰腺炎患者进行最佳治疗，需要包括胃肠病学家、外科医生和疼痛管理医生在内的多学科团队密切合作。
