Ell C
Medizinische Klinik I mit Poliklinik der FAU, Erlangen-Nürnberg.
Praxis (Bern 1994). 1994 Nov 15;83(46):1292-5.
In chronic pancreatitis high-dose enzyme therapy is only indicated if an insufficiency of the exocrine gland exists. For pain conventional analgesics such as Paracetamol, Metamizol or Tramadol are indicated. In case of pancreolithiasis, ESWL is the method of choice. This treatment should be combined with papillotomy of the pancreatic sphincter to achieve a good access to the duct system. If strictures are seen during ERCP, balloon dilatation and consecutive implantation of a plastic prosthesis are necessary to permit regular flow of pancreatic juice. Stent-clogging is the main problem of drainage-procedures. Regular exchange of the stent is mandatory. Pseudocysts should be drained via the papilla if there is a connection between the cyst and the duct system. All others should be drained endoscopically, by puncturing the cyst through the gastric or duodenal wall, or percutaneously. Surgical procedures should be delayed whenever possible, since surgical treatment is invasive (e.g. Whipple's operation) and the long-term prognosis is poor.
在慢性胰腺炎中，仅当存在外分泌腺功能不全时才采用高剂量酶疗法。对于疼痛，可使用对乙酰氨基酚、安乃近或曲马多等传统镇痛药。对于胰石症，体外冲击波碎石术（ESWL）是首选方法。这种治疗应与胰括约肌切开术相结合，以便能良好地进入导管系统。如果在逆行胰胆管造影（ERCP）过程中发现狭窄，气囊扩张并随后植入塑料支架对于保证胰液正常流动是必要的。支架堵塞是引流手术的主要问题，必须定期更换支架。如果假性囊肿与导管系统相通，则应通过乳头进行引流。其他所有假性囊肿都应通过内镜，即经胃壁或十二指肠壁穿刺囊肿进行引流，或经皮引流。只要有可能，手术应推迟进行，因为手术治疗具有侵入性（如惠普尔手术）且长期预后较差。
