Pap A, Topa L, Berger Z, Flautner L, Varró V
Second Dept. of Medicine, St. Imre Hospital, Budapest, Hungary.
Scand J Gastroenterol Suppl. 1998;228:98-106. doi: 10.1080/003655298750026624.
Pain and functional deterioration in chronic pancreatitis is multifactorial. Early surgery in non-alcoholic patients with mild to moderate chronic pancreatitis can relieve pain and prevent progression of pancreatic insufficiency for some time, but the good results are only short term. Endoscopic intervention can relieve pain and recover pancreatic function without surgery.
To achieve the burned out state of chronic pancreatitis, occlusion of the pancreatic duct was first attempted by our team with Ethibloc at ERCP. Temporary obstruction of the pancreatic duct did not result in a long-lasting symptom and relapse-free situation because of early recovery of pancreatic function. On the contrary, endoscopic simple and double papillotomy, pancreatic drainage with citrate lavage, biliary endoprosthesis with multiple stents and endoscopic decompression of pseudocysts with or without jejunal feeding resulted in pain-free patients for a considerable time and in several cases significant functional recovery occurred. In cases where pain remained, percutaneous celiac plexus block with long-lasting steroids can be applied and only if all of these treatments fail should surgery be recommended.
Endoscopic intervention can successfully substitute for surgery for chronic pancreatitis in individual cases.
慢性胰腺炎的疼痛和功能恶化是多因素导致的。非酒精性轻度至中度慢性胰腺炎患者早期手术可缓解疼痛并在一段时间内预防胰腺功能不全的进展，但良好效果仅为短期。内镜干预可在不进行手术的情况下缓解疼痛并恢复胰腺功能。
为达到慢性胰腺炎的“耗竭状态”，我们团队首先尝试在ERCP时用Ethibloc阻塞胰管。由于胰腺功能早期恢复，胰管的临时阻塞并未导致持久的症状和无复发情况。相反，内镜下单乳头和双乳头切开术、柠檬酸盐灌洗的胰腺引流、多支架胆道内支架置入术以及有无空肠营养的假性囊肿内镜减压术，使患者在相当长的时间内无痛，并且在一些病例中出现了显著的功能恢复。对于仍有疼痛的病例，可应用长效类固醇进行经皮腹腔神经丛阻滞，只有在所有这些治疗均失败时才建议手术。
内镜干预在个别病例中可成功替代慢性胰腺炎的手术治疗。
