Murruste Marko, Kirsimägi Ülle, Kase Karri, Veršinina Tatjana, Talving Peep, Lepner Urmas
Department of Surgery, Tartu University Hospital, Tartu 50406, Estonia.
Department of Surgery, Board, North Estonia Medical Centre, Tallinn 13419, Estonia.
World J Clin Cases. 2022 Aug 6;10(22):7808-7824. doi: 10.12998/wjcc.v10.i22.7808.
Chronic pancreatitis (CP) is a long-lasting disease frequently associated with complications for which there is no comprehensive pathophysiological classification.
The aims of this study were to: Propose a pathophysiological classification of the complications of CP; evaluate their prevalence in a surgical cohort prior to, and following surgical management; and assess the impact of the surgical treatment on the occurrence of new complications of CP during follow-up. We hypothesized that optimal surgical treatment can resolve existing complications and reduce the risk of new complications, with the exclusion of pancreatic insufficiency. The primary outcomes were prevalence of complications of CP at baseline (prior to surgical treatment) and occurrence of new complications during follow-up.
After institutional review board approval, a prospective observational cohort study with long-term follow-up (up to 20.4 years) was conducted. All consecutive single-center adult patients (≥ 18 years of age) with CP according to the criteria of the American Pancreas Association subjected to surgical management between 1997 and 2021, were included. The prevalence of CP complications evaluated, according to the proposed classification, in a surgical cohort of 166 patients. Development of the pathophysiological classification was based on a literature review on the clinical presentation, course, and complications of CP, as well a review of previous classification systems of CP.
We distinguished four groups of complications: Pancreatic duct complications, peripancreatic complications, pancreatic hemorrhages, and pancreatic insufficiency (exocrine and endocrine). Their baseline prevalence was 20.5%, 23.5%, 10.2%, 31.3%, and 27.1%, respectively. Surgical treatment was highly effective in avoiding new complications in the first and third groups. In the group of peripancreatic complications, the 15-year Kaplan-Meier prevalence of new complications was 12.1%. The prevalence of pancreatic exocrine and endocrine insufficiency increased during follow-up, being 66.4% and 47.1%, respectively, at 15 years following surgery. Pancreatoduodenal resection resulted optimal results in avoiding new peripancreatic complications, but was associated with the highest rate of pancreatic exocrine insufficiency.
The proposed complication classification improves the understanding of CP. It could be beneficial for clinical decision making, as it provides an opportunity for more comprehensive judgement on patient's needs on the one hand, and on the pros and cons of the treatment under consideration, on the other. The presence of complications of CP and the risk of development of new ones should be among the main determinants of surgical choice.
慢性胰腺炎（CP）是一种常伴有并发症的持久性疾病，目前尚无全面的病理生理分类。
本研究的目的是：提出CP并发症的病理生理分类；评估其在手术治疗前后手术队列中的患病率；并评估手术治疗对随访期间CP新并发症发生的影响。我们假设最佳手术治疗可以解决现有并发症并降低新并发症的风险，但不包括胰腺功能不全。主要结局是基线时（手术治疗前）CP并发症的患病率以及随访期间新并发症的发生情况。
经机构审查委员会批准后，进行了一项具有长期随访（长达20.4年）的前瞻性观察队列研究。纳入了1997年至2021年间所有根据美国胰腺协会标准接受手术治疗的连续单中心成年CP患者（≥18岁）。在166例患者的手术队列中，根据提议的分类评估CP并发症的患病率。病理生理分类的制定基于对CP临床表现、病程和并发症的文献综述以及对CP先前分类系统的综述。
我们区分了四组并发症：胰管并发症、胰腺周围并发症、胰腺出血以及胰腺功能不全（外分泌和内分泌）。它们的基线患病率分别为20.5%、23.5%、10.2%、31.3%和27.1%。手术治疗在避免第一组和第三组出现新并发症方面非常有效。在胰腺周围并发症组中，新并发症的15年Kaplan-Meier患病率为12.1%。随访期间胰腺外分泌和内分泌功能不全的患病率增加，术后15年分别为66.4%和47.1%。胰十二指肠切除术在避免新的胰腺周围并发症方面取得了最佳效果，但与胰腺外分泌功能不全的发生率最高相关。
提议的并发症分类提高了对CP的认识。它可能有助于临床决策，因为它一方面为更全面地判断患者需求提供了机会，另一方面也为考虑中的治疗的利弊提供了机会。CP并发症的存在以及新并发症发生的风险应是手术选择的主要决定因素之一。
