ISSN:0253-4886    

DOI:10.1159/000172408

出版商:S. Karger AG    

年代:1996

数据来源: Karger

ISSN:0253-4886    

DOI:10.1159/000172409

出版商:S. Karger AG    

年代:1996

数据来源: Karger

ISSN:0253-4886    

DOI:10.1159/000172410

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

The perception of pain depends upon signals carried by nerves to appropriate locations in the central nervous system. It is well known that when stretch receptors in the gastrointestinal tract are stimulated, pain may be experienced. Thus it is reasonable to suppose that pain may be produced by pressure within the ductal system in chronic pancreatitis. There is evidence that pressures are elevated in chronic pancreatitis. Ischemia and anoxia, as a result of changes in circulation, may be stimulants of pain, as can altered pH. Inflammation can initiate pain by stimulating intact nerves or by damaging nerves. Pancreatic nerves found in chronic pancreatitis are enlarged and numerous. Foci of chronic inflammatory cells sometimes are intimately associated with nerves. In these areas, the perineurium, nerve fibers and Schwann cells may be damaged. Inflammatory cells, their products, and noxious substances may gain access to the nerves because of this damage, initiating impulses interpreted in the central nervous system as pain. In addition, stimulation of efferent nerves may affect secretion and blood flow.

ISSN:0253-4886    

DOI:10.1159/000172411

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Pain and malabsorption are the main and most frequent manifestations of chronic pancreatitis (CP) requiring treatment. Abstinence from alcohol and administration of analgesics are primary measures for pain in CP. Pain relief by suppressing exocrine pancreatic secretion either with high doses of pancreatic enzyme preparations or other means may be attempted. Endoscopic interventions to drain the pancreatic duct may be useful in selected cases. If nonoperative measures fail to alleviate pain and if pain interferes significantly with the quality of life, surgery should be considered. In our opinion, celiac plexus block and epidural anesthesia are restricted to few cases of intractable pain if they are unsuitable for surgery. Treatment of steatorrhea is based on dietary and pancreatic enzyme substitution. Entericcoated pancreatic extracts with high lipolytic activity are required to reduce fecal fat excretion. In addition, inhibition of gastric acid secretion may be occasionally required. The present review deals with the different conservative therapeutical measures for management of pain and steatorrhea in patients with CP.

ISSN:0253-4886    

DOI:10.1159/000172412

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Recent advances in molecular and cellular biology have generated a better understanding of chronic pancreatitis. This disease is characterised histologically by a progressive inflammatory disease with irreversible pathological changes leading to insufficient secretion from both the exocrine and endocrine pancreas. The most common complications in chronic pancreatitis are intractable pain and the development of complicated pseudocysts. The present review will deal with these complications as well as bleeding, pancreatic ascites and pleural effusions, jaundice, and intestinal obstruction. Each complication will be described in detail with their pathogenesis and their medical, interventional and surgical treatment options.

ISSN:0253-4886    

DOI:10.1159/000172413

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Treatment of chronic pancreatitis has traditionally been relegated to medical or surgical therapy. Aim: This article attempts to place pancreatic endotherapy into the perspective of current treatment modalities. Materials and Methods: Personal experience and literature review. Results: Endotherapy attempts to mimic portions of our current surgical and interventional radiologic maneuvers: treatment of ductal disruption or obstruction. As such, ERCP has been used to approach stenosis of the major or minor papilla, ductal calculi or strictures, and ductal leak with its attendant consequences of pancreatic ascites, pleural effusion, pseudocyst or pancreaticocutaneous fistulae. Conclusions: Despite a paucity of controlled clinical trials, the authors feel that endotherapy has an evolving role to play in a variety of problems associated with chronic pancreatitis.

ISSN:0253-4886    

DOI:10.1159/000172414

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Pancreatic pseudocysts are managed selectively based on evolving understanding of their natural history. Peripancreatic collections in acute pancreatitis often resolve spontaneously and thus do not usually need drainage. Pseudocysts in chronic pancreatitis are less likely to resolve and more often require treatment. Drainage of pancreatic pseudocysts is indicated for persistent symptoms, cyst enlargement or recurrence, or the development of cyst-related complications. Drainage can be achieved by operative, percutaneous or endoscopic approaches. Selection of the appropriate method of drainage is controversial and influenced by multiple considerations. Pseudocysts in chronic pancreatitis are usually best treated by operative internal drainage which leads to cyst resolution and symptomatic relief for most patients. Factors that determine long-term functional results after operative drainage include the etiology of the pancreatitis, continued alcohol use, and the completeness of decompression in patients with a dilated pancreatic duct.

ISSN:0253-4886    

DOI:10.1159/000172415

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Chronic pancreatitis should be managed medically until a surgical correctable complication develops. The ‘ideal’ operation should have a low mortality and morbidity, be easy to perform, provide pain relief, rectify the structural abnormalities such as bile duct obstruction, and not augment exocrine and endocrine insufficiency. Direct measurements made at the time of laparotomy have shown that at least some patients with chronic pancreatitis and dilated ducts or pseudocysts had raised intraductal pressure. Drainage operations for chronic pancreatitis are based on the concept that obstruction of the main pancreatic duct(s) leads to an increased intraductal and intraparenchymal pressure, and that this, in turn, gives rise to pain. For a long time a longitudinal pancreaticojejunostomy according to Partington and Rochelle, i.e. the duct of Wirsung opened from tail of pancreas to the duodenum and anastomosed to the side of the jejunum, has been one of the techniques that has been used most often. There is little evidence that the procedure delays the development of endocrine and exocrine insufficiency. This implies that this option should not be chosen early in the disease, but rather when pain control is out of hand after medical managem

ISSN:0253-4886    

DOI:10.1159/000172416

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Pancreaticoduodenectomy remains the gold standard for the various resection operations that are used to treat pain in chronic pancreatitis. It is used most commonly when: (1) the pancreatic duct is normal in diameter; (2) the head of the pancreas is enlarged, and contains calcifications and cysts; (3) a previous drainage procedure was ineffective, and, even in the absence of pain, (4) when there is concern about the presence of a pancreatic neoplasm in the head of the gland. The operative mortality rate is < 5%, and about 90% of patients experience long-term pain relief.

ISSN:0253-4886    

DOI:10.1159/000172417

出版商:S. Karger AG    

年代:1996

数据来源: Karger