云南省慢性胰腺炎的病因及临床诊治研究
摘要
目的：研究云南省慢性胰腺炎的病因及诊治。
方法：回顾性分析云南省6所省市级综合医院(2003-01-01/2010-12-31)8年间确诊为慢性胰腺炎(CP)的430例患者的病因、诊断和治疗。
结果：
1、云南省CP多见于中年男性,男：女为2.9：1。男性以40-50岁为最多(28.8%),其次为30-40岁(20.6%)、50-60岁(17.2%)。女性以50-60岁为最多(20.9%),其次为70岁以上(16.4%)、10-20岁(15.5%)
2、430例CP患者中有50.5%的患者有吸烟史,病因中胆系疾病占37.2%,洒精因素占42.1%,胰石症占29.5%,急性胰腺炎占22.8%,腹部手术史者占30.2%,多因素致病者占66.0%。前四年与后四年CP患者例数之比为1：1.59,其中患胆系疾病和饮洒者分别占39.8%、36.1%；35.6%、45.8%.男性患者以洒精为
主,占56.3%；女性患者以胆道疾病为主,占32.7%。
3、CP易复发,腹痛是其最主要和最常见的症状,占93.3%；其次为消瘦(29.1%)和腹胀(13.5%)。199(46.3%)例CP患者出现了并发症,并发胰腺假性囊肿者187(43.5%)例。成功随访154例,其中6.5%的患者出现癌变。
4、430例CP患者均未行胰腺外分泌功能检查和大多数胰腺内分泌功能检查。影像学检查中CT、MRI、MRCP阳性率较高,分别为96.9%、96.1%、94.4%；灵敏度较高,分别为96.3%、96.2%、96.1%。
5、430例CP患者中,内科治疗者占80.5%,其中使用抑酸剂者最多(占89.9%),使用胰酶制剂者次之(占33.8%)；外科治疗者占40.5%,以采用胰肠吻合术式者最多(69.2%)；内镜介入治疗者极少占(4.4%)。
结论：云南省CP患者呈逐年增高趋势,患病率为0.32-0.34‰。CP多见与中年男性,以40-50岁为最多,男：女为2.9：1。50%以上的CP患者有吸烟史。CP的病因中以胆系疾病和洒精因素为主。近年来洒精已取代胆道疾病成为CP的第一致病因素。胰石症、急性胰腺炎、腹部手术史所占比重亦大,半数以上患者由多因素共同致病。腹痛是CP患者最主要和最常见症状,其次为消瘦、腹胀。CP并发症发生率高,以胰腺假性囊肿为主。云南省在CP的诊治中,未开展胰腺外分泌功能的相关检查和大多数胰腺内分泌功能检查,目前诊断CP主要依靠症状和影像学检查。对于云南省的CP患者,CT、MRI、MRCP阳性率较高、灵敏度较高,可作为诊断CP的首选影像学检查。目前CP治疗仍以内科治疗为主,外科治疗次之,内镜介入治疗者极少。绝大多数内科治疗采用抑酸剂,胰酶制剂、奥曲肽和生长抑素应用比例相当(30.3-33.8%)。胰肠吻合术仍为外科治疗的主要术式。CP癌变率高,易复发,应注重长期随访。
AIM:To investigate the etiology, diagnosis and treatment of chronic pancreatitis in Yunnan Province.
METHODS:430patients with confirmed chronic pancreatitis in6provincial and municipal general hospitals of Yunnan Province between eight years (2003-01-01/2010-12-31) were retrospectively studied, including investigating their associated etiological factors, diagnostic and therapeutic methods.
RESULTS:
1、 In Yunnan province, CP is more common in middle-aged men, male:female is2.9:1. Males with40-50ages is the most (28.8%), followed by30-40(20.6%),50-60(17.2%). Women with50-60ages is the most (20.9%), followed by over70years of age (16.4%),10-20(15.5%).
2、In430cases of CP patients, the patients of50.5%had a history of smoking. Suffering from biliary diseases accounted for37.2%and42.1%of drinkers,29.5%of pancreatic stone disease,22.8%of acute pancreatitis,30.2%of abdominal surgery,66.0%of multiple pathogenic factors. Before and after four years, the ratio of patients with CP was1:1.59and suffering from biliary diseases and drinkers were accounted for39.8%,36.1%;35.6%,45.8%. In male patients, alcohol is the main pathogenic factor accounting for56.3%, and in females biliary diseases is the main pathogenic factor accounting for32.7%.
3、CP is easy to recur, abdominal pain is the most important and the most common symptoms, accounted for93.3%; followed by weight loss (29.1%) and abdominal distension (13.5%).199(46.3%) CP patients developed complications, and187(43.5%) cases complicated pancreatic pseudocysts. Successfully followed-up 154cases, of which6.5%patients appeared cancerous.
4、430cases of CP patients done no pancreatic exocrine function examination and the majority of pancreatic endocrine function test. In the imaging examination, positive rate of CT、MRI、MRCP is higher, they were96.9%,96.1%,94.4%; their sensitivity is higher, they were96.3%、96.2%、96.1%.
5、In430cases of CP patients, the patients of medical treatment accounted for80.5%, in which using the antacid take the most (89.9%), using the pancreatic enzyme preparation take second place (33.8%); Surgical treatment for40.5%, in which adopting pancreatic bowel anastomosis take the most (69.2%); Endoscopic intervention is few (4.4%).
CONCLUSION:In Yunnan Province, CP patients showed a trend of increase year by year, the prevalence rate is0.32-0.34%o. CP is more common in middle-aged men and40-50ages are the most, male:female is2.9:1. More than50%of the CP patients have a smoking history, biliary disease and alcohol factor are the main factors of CP. In recent years, alcohol has replaced biliary diseases become the CP first etiological factor. Pancreatic stone disease, acute pancreatitis, abdominal surgery has also a large proportion, More than half of patients suffer from multiple pathogenic factors. Abdominal pain is the most important and the most common symptoms, followed by weight loss, abdominal distension. CP complication rate is high, mainly with pancreatic pseudocysts. In the diagnosis and treatment of CP, Yunnan Province does not begin pancreatic exocrine function examination and the majority of pancreatic endocrine function test,at present, diagnosis of CP mainly depends on the symptoms and radiographic examination.For the patients with CP in Yunnan Province, positive rate and sensitivity of CT、MRI、,MRCP are higher, can be used as the first choice of CP imaging diagnosis. At present treatment of CP is still medical treatment to give priority to, surgical treatment is the second smallest, and endoscopic intervention is few. The vast majority of medical treatment use acid suppression, but pancreatin, octreotide and somatostatin's application scale is similar (30.3-33.8%). Pancreatic bowel anastomosis remains the main operation type of the surgical treatment. CP canceration rate is high, easy to recur, should pay attention to long term follow-up.
方法：回顾性分析云南省6所省市级综合医院(2003-01-01/2010-12-31)8年间确诊为慢性胰腺炎(CP)的430例患者的病因、诊断和治疗。
结果：
1、云南省CP多见于中年男性,男：女为2.9：1。男性以40-50岁为最多(28.8%),其次为30-40岁(20.6%)、50-60岁(17.2%)。女性以50-60岁为最多(20.9%),其次为70岁以上(16.4%)、10-20岁(15.5%)
2、430例CP患者中有50.5%的患者有吸烟史,病因中胆系疾病占37.2%,洒精因素占42.1%,胰石症占29.5%,急性胰腺炎占22.8%,腹部手术史者占30.2%,多因素致病者占66.0%。前四年与后四年CP患者例数之比为1：1.59,其中患胆系疾病和饮洒者分别占39.8%、36.1%；35.6%、45.8%.男性患者以洒精为
主,占56.3%；女性患者以胆道疾病为主,占32.7%。
3、CP易复发,腹痛是其最主要和最常见的症状,占93.3%；其次为消瘦(29.1%)和腹胀(13.5%)。199(46.3%)例CP患者出现了并发症,并发胰腺假性囊肿者187(43.5%)例。成功随访154例,其中6.5%的患者出现癌变。
4、430例CP患者均未行胰腺外分泌功能检查和大多数胰腺内分泌功能检查。影像学检查中CT、MRI、MRCP阳性率较高,分别为96.9%、96.1%、94.4%；灵敏度较高,分别为96.3%、96.2%、96.1%。
5、430例CP患者中,内科治疗者占80.5%,其中使用抑酸剂者最多(占89.9%),使用胰酶制剂者次之(占33.8%)；外科治疗者占40.5%,以采用胰肠吻合术式者最多(69.2%)；内镜介入治疗者极少占(4.4%)。
结论：云南省CP患者呈逐年增高趋势,患病率为0.32-0.34‰。CP多见与中年男性,以40-50岁为最多,男：女为2.9：1。50%以上的CP患者有吸烟史。CP的病因中以胆系疾病和洒精因素为主。近年来洒精已取代胆道疾病成为CP的第一致病因素。胰石症、急性胰腺炎、腹部手术史所占比重亦大,半数以上患者由多因素共同致病。腹痛是CP患者最主要和最常见症状,其次为消瘦、腹胀。CP并发症发生率高,以胰腺假性囊肿为主。云南省在CP的诊治中,未开展胰腺外分泌功能的相关检查和大多数胰腺内分泌功能检查,目前诊断CP主要依靠症状和影像学检查。对于云南省的CP患者,CT、MRI、MRCP阳性率较高、灵敏度较高,可作为诊断CP的首选影像学检查。目前CP治疗仍以内科治疗为主,外科治疗次之,内镜介入治疗者极少。绝大多数内科治疗采用抑酸剂,胰酶制剂、奥曲肽和生长抑素应用比例相当(30.3-33.8%)。胰肠吻合术仍为外科治疗的主要术式。CP癌变率高,易复发,应注重长期随访。
AIM:To investigate the etiology, diagnosis and treatment of chronic pancreatitis in Yunnan Province.
METHODS:430patients with confirmed chronic pancreatitis in6provincial and municipal general hospitals of Yunnan Province between eight years (2003-01-01/2010-12-31) were retrospectively studied, including investigating their associated etiological factors, diagnostic and therapeutic methods.
RESULTS:
1、 In Yunnan province, CP is more common in middle-aged men, male:female is2.9:1. Males with40-50ages is the most (28.8%), followed by30-40(20.6%),50-60(17.2%). Women with50-60ages is the most (20.9%), followed by over70years of age (16.4%),10-20(15.5%).
2、In430cases of CP patients, the patients of50.5%had a history of smoking. Suffering from biliary diseases accounted for37.2%and42.1%of drinkers,29.5%of pancreatic stone disease,22.8%of acute pancreatitis,30.2%of abdominal surgery,66.0%of multiple pathogenic factors. Before and after four years, the ratio of patients with CP was1:1.59and suffering from biliary diseases and drinkers were accounted for39.8%,36.1%;35.6%,45.8%. In male patients, alcohol is the main pathogenic factor accounting for56.3%, and in females biliary diseases is the main pathogenic factor accounting for32.7%.
3、CP is easy to recur, abdominal pain is the most important and the most common symptoms, accounted for93.3%; followed by weight loss (29.1%) and abdominal distension (13.5%).199(46.3%) CP patients developed complications, and187(43.5%) cases complicated pancreatic pseudocysts. Successfully followed-up 154cases, of which6.5%patients appeared cancerous.
4、430cases of CP patients done no pancreatic exocrine function examination and the majority of pancreatic endocrine function test. In the imaging examination, positive rate of CT、MRI、MRCP is higher, they were96.9%,96.1%,94.4%; their sensitivity is higher, they were96.3%、96.2%、96.1%.
5、In430cases of CP patients, the patients of medical treatment accounted for80.5%, in which using the antacid take the most (89.9%), using the pancreatic enzyme preparation take second place (33.8%); Surgical treatment for40.5%, in which adopting pancreatic bowel anastomosis take the most (69.2%); Endoscopic intervention is few (4.4%).
CONCLUSION:In Yunnan Province, CP patients showed a trend of increase year by year, the prevalence rate is0.32-0.34%o. CP is more common in middle-aged men and40-50ages are the most, male:female is2.9:1. More than50%of the CP patients have a smoking history, biliary disease and alcohol factor are the main factors of CP. In recent years, alcohol has replaced biliary diseases become the CP first etiological factor. Pancreatic stone disease, acute pancreatitis, abdominal surgery has also a large proportion, More than half of patients suffer from multiple pathogenic factors. Abdominal pain is the most important and the most common symptoms, followed by weight loss, abdominal distension. CP complication rate is high, mainly with pancreatic pseudocysts. In the diagnosis and treatment of CP, Yunnan Province does not begin pancreatic exocrine function examination and the majority of pancreatic endocrine function test,at present, diagnosis of CP mainly depends on the symptoms and radiographic examination.For the patients with CP in Yunnan Province, positive rate and sensitivity of CT、MRI、,MRCP are higher, can be used as the first choice of CP imaging diagnosis. At present treatment of CP is still medical treatment to give priority to, surgical treatment is the second smallest, and endoscopic intervention is few. The vast majority of medical treatment use acid suppression, but pancreatin, octreotide and somatostatin's application scale is similar (30.3-33.8%). Pancreatic bowel anastomosis remains the main operation type of the surgical treatment. CP canceration rate is high, easy to recur, should pay attention to long term follow-up.
引文
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