慢性胰腺炎合并胰管结石的诊断和治疗1.docVIP

慢性胰腺炎合并胰管结石的诊断和治疗 　　Pancreatic Head Resection Versus Pancreatoduodenectomy for 　　Surgical Treatment of Chronic Pancreatitis . A Systematic Re-view and Meta-analysis [J ]. Ann Surg, 2008, 247(6):950-961. [11]Jakob R,Emre F, Yekebas. Chronic pancreatitis:modern surgi-cal management[J ]. Langenbecks Arch Surg, 2011,396(1):139-149. 　　(2011-07-06收稿 ) 文章编号:1005-2208(2011) 09-0800-04慢性胰腺炎合并胰管结石的 诊断和治疗 苗 毅, 蒋奎荣 【 摘要 】 慢性胰腺炎是由于多种原因 (酗酒、 胆道系统疾病 等) 造成的胰腺组织结构和功能持续性损害, 常合并胰管 　　结石。疼痛是其最主要症状, 同时常伴有消化不良、 脂肪 泻、 糖尿病等并发症。结合多种影像学检查方法如 B 超、 CT 、 ERCP 和磁共振胰胆管造影 (MRCP ) 等能明显提高慢性 胰腺炎合并胰管结石的确诊率。慢性胰腺炎合并胰管结 石应予以积极治疗, 以控制症状、 改善胰腺功能和治疗并 发症为重点, 强调以个体化治疗为原则的综合治疗。在体 外震波碎石及内镜取石不彻底而症状不能控制或结石复 发者应尽早手术治疗, 根据结石分布范围选择相应的治疗 方式, 彻底去除病灶, 取净结石, 解除胰、 胆管梗阻, 充分引 流胰液, 同时注意尽量保存胰腺组织功能, 可明显改善病 人生存质量。 【 关键词 】 慢性胰腺炎; 胰管结石 中图分类号:R6文献标志码:A Diagnosis treatment of chronic pancreatitis combinded with pancreatic duct stones MIAO Yi,JIANG Kui-rong. Department of Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China Corresponding author:MIAOYi,E-mail:miaoyi@Abstract Chronic pancreatitis is a progressive fibroinflammatory disease 　　with sustained damage of structure 　　and function of pancreatic tissue, which 　　results 　　from a complex 　　mix of causes (eg,alcohol, Biliary diseases), and often exists with intraductal calculi. Pain in the form of recurrent attacks of pancreatitis or constant and disabling pain is usually the main symptom. Steatorrhoea, diabetes, local complications are additional therapeutic challenges. 　　Combined with a variety of imaging methods such 　　as BUS, 　　CT, ERCP and MRCP, 　　etc. can significantly improve 　　the diagnosis of chronic pancreatitis with 　　pancreatic 　　duct 　　stone. Chronic pancreatitis with pancreatic duct stones should be actively treated, of which the focus is to control symptoms, improve function and treatment 　　of 　　complications with individual therapy. 　　The 　　appropriate surgery should be 　　performed as soon as possible according to distributio