Belyaev Orlin, Uhl Waldemar
Klinik für Allgemein- und Viszeralchirurgie, St. Josef-Hospital, Universitätsklinikum der Ruhr-Universität Bochum.
Zentralbl Chir. 2018 Dec;143(6):586-595. doi: 10.1055/a-0647-7088. Epub 2018 Sep 4.
Continuously rising incidence and prevalence, frequent hospitalisation, development of opioid dependence, and early retirement of young people demonstrate the enormous socioeconomic impact of chronic pancreatitis. The aims of therapy include pain relief, improved quality of life, management of complications, cancer prevention and preservation of function. Since medical and endoscopic approaches of conservative therapy have proved to be ineffective in the long term, surgery remains the mainstay of treatment and should be considered as early as possible. Surgery encompasses a wide spectrum of methods, ranging from simple drainage procedures and conventional resections to various hybrid techniques. The choice of optimal surgical management should consider the unique pathomorphologic changes of each patient and be performed at a high-volume pancreas centre. This review presents the current evidence-based state of knowledge about chronic pancreatitis from a surgical point of view with a practical summary of therapeutic strategies according to the available guidelines and considering the most recent literature.
慢性胰腺炎发病率和患病率持续上升、频繁住院、阿片类药物依赖的发展以及年轻人提前退休,这些都表明了慢性胰腺炎对社会经济产生的巨大影响。治疗目标包括缓解疼痛、提高生活质量、处理并发症、预防癌症以及保留功能。由于保守治疗的药物和内镜方法长期来看已被证明无效,手术仍然是主要的治疗手段,应尽早考虑。手术涵盖了广泛的方法,从简单的引流手术和传统切除术到各种混合技术。最佳手术管理的选择应考虑每位患者独特的病理形态学变化,并在大型胰腺中心进行。本综述从外科角度呈现了关于慢性胰腺炎的当前循证知识状态,并根据现有指南并参考最新文献对治疗策略进行了实用总结。