胰腺外分泌功能不全的治疗—培训课件.pptVIP

EUS Surveillance: Sendai 指南 2012 2-3cm EUS in 3-6 months, then lengthen interval alternating MRI with EUS as appropriate. Consider surgery in young, fit patients with need for prolonged surveillance 3cm Close surveillance alternating MRI with EUS every 3-6months. Strongly consider surgery in young, fit patients CT/MRI in 2-3 years CT/MRI yearly for 2 years Lengthen interval if no change. 1-2cm 1 cm Validation of Sendai Guidelines Factors predictive of malignancy Mural nodule MPD＞5mm CA19-9＞37 Wall thickness Number of factor(1-4) 1:accuracy 44% 2:accuracy 68% 3:accuracy 87% 4:accuracy 89%:sensitivity 91% specificity 90% SUMMARY PEI 治疗---目标、方法（剂量）和效果 胰酶活性10% → PEI→都应接受PERT治疗 PEI必须充分治疗(慢性胰腺炎、胰腺癌术后…) 优化治疗(≥4-5万U脂肪酶/餐)可改善病人营养状况 2104 ACG 胰腺疾病专题报告和文献文献学习 SAP：SIRS灵；Intervention拖；Nutrition早… CP: 补充胰酶→内镜→外科； TPIAT+PERT… Cyst：Sendai Guidelines 预测恶性 4321 Copyright ? 2011 Abbott. All rights reserved. 谢 谢 大 家 ! 胰酶迅速释放到十二指肠中，在餐后前1个小时内达到最高水平。峰值过后，在餐后约3-4个小时以后再次降低之前，酶分泌降至相当稳定的分泌速度。最终，到消化期间结束时，胰酶水平达到消化间期范围。 因此，为能达到适当疗效，用PERT治疗PEI应能在酶的给药时机和水平方面都与上述模式类似。 参考文献 Keller J, Layer P. Human pancreatic exocrine response to nutrients in health and disease. Gut. 2005;54(Suppl VI):vi1-vi28. * 正常胰酶分泌量因进餐量而异，脂肪酶分泌量平均为每餐720,000。1 为避免出现脂肪吸收不良，脂肪酶分泌量必须达到正常值的5-10%以上。因此，在出现吸收不良之前，腔内胰腺活动必须10%。1,2 参考文献 Keller J, Layer P. Human pancreatic exocrine response to nutrients in health and disease. Gut. 2005;54(Suppl VI):vi1-vi28. Layer P, Zinsmeister AR, DiMagno EP. Effects of decreasing intraluminal amylase activity on starch digestion and postprandial gastrointestinal function in humans. Gastroenterology. 1986;91(1):41-48. * 不管是否存在脂肪痢和相关症状，每位PEI 患者都应接受PERT治疗。 ? 参考文献 Sikkens ECM, Cahen DL, Kuipers KJ. Pancreatic enzyme replacement therapy in chronic pancreatitis. Best Pract Res Clin Gastroenterol. 2010;(24):337-347. * 采用PERT管理PEI的治疗目标包括缓解脂肪痢、减少便次、改善粪便稠度、预防体重减轻或增加体重以及恢复或维持良好的营养状态。1,2 参考文献 Dominguez-Munoz JE. Pancreatic enzyme therapy for pancreatic exocrine insufficiency. C