ISSN:0257-2753    

DOI:10.1159/000171368

出版商:S. Karger AG    

年代:1992

数据来源: Karger

ISSN:0257-2753    

DOI:10.1159/000171369

出版商:S. Karger AG    

年代:1992

数据来源: Karger

ISSN:0257-2753    

DOI:10.1159/000171370

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

The pathogenesis of acute pancreatitis even if associated with gallstone remains unclear. This explains that the best treatment for gallstone-associated pancreatitis remains a matter of debate. However, different theoretical and clinical evaluations support the strategy to perform an endoscopic papillotomy if a common bile duct stone is suspected and the course of the disease does not improve spontaneously during the first 48 h. The discrepancies of the current data and the difficulties to give rational suggestions have been reviewed.

ISSN:0257-2753    

DOI:10.1159/000171371

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Specific points of physiology which are relevant for the understanding and management of chronic pancreatitis are focussed on. First, the regulatory factors of exocrine pancreatic secretion are described, discussing the role of the cholinergic system and of the classical gut hormones cholecystokinin and secretin. The association of upper gastrointestinal dysfunctions with a disturbed exocrine pancreatic response is also dealt with. Lastly, these changes are related to clinical consequences such as maldigestion or malabsorption.

ISSN:0257-2753    

DOI:10.1159/000171372

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

This paper is a review of some aspects of acute pancreatitis (AP) (definition criteria, outcome, and prognostic factors) and a reminder of the invaluable contribution of computed tomography (CT) in confirming the diagnosis of AP, distinguishing between edematous and necrotizing forms, and in providing prognostic information via detection of possible extrapancreatic spreads (EPS). The Geneva experience (510 cases of AP over a 9-year period) has shown that no fatalities occurred when no EPS were found on CT performed within 48 h of admission; mortality was 1.5% in the case of 1 or 2 EPS and 19 % in the case of 3 EPS or more.

ISSN:0257-2753    

DOI:10.1159/000171373

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Chronic pancreatitis (CP) is a rare but serious disease with high morbidity and mortality. Its exact etiology remains uncertain, but several associated conditions have been identified. Geographical distribution of CP can be linked to alcoholism, especially in countries with high-protein, high-fat diets. In Afro-Asiatic countries with protein malnutrition, however, CP is frequently observed in children and young nonalcoholic adults from the poorest segments of these societies. To analyze the natural history of CP, besides etiology three additional main factors have to be considered, namely clinical pattern and therapy (surgery), pancreatic function (endocrine and exocrine), and morphology. During progress of the disease clinical picture, morphology and pancreatic function have typical correlative changes. Basically, from this viewpoint, three typical models of the disease can be distinguished: (1) early stage of uncomplicated CP; (2) late stage of uncomplicated CP, and (3) complicated CP, a disease stage which is characterised by local complications (chiefly pseudocysts and duct obstruction). The main concept of the natural history of CP bases on the thesis that CP burns itself out with spontaneous relief of pain, i.e. persistent freedom from pain occurs parallel with severe pancreatic dysfunction in the late stage of the disease. In the clinical picture and long-term course, nonalcoholic CP differs in certain essential respects from alcoholic CP; however, the two forms do not differ essentially as regards mortality and survival.

ISSN:0257-2753    

DOI:10.1159/000171374

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Relief of pain in chronic pancreatitis is the major problem warranting surgical treatment in this disease. The mechanism of pain is largely unknown and several types of operation have been devised for treatment. Side-to-side pancreaticojejunostomy (Partington-Rochelle) and pancreaticoduodenectomy according to Whipple have stood the test of time. Recently, new surgical options have been explored like the operation according to Beger, segmental autotransplantation, and duodenum-preserving total pancreatectomy. Because of the reluctance to refer this type patient for surgery, treatment with analgesic drugs is continued for quite some time and once analgesia addiction has developed clinical judgement in these patients is severely hampered. Surgery can be performed with 70-80% success and with limited morbidity as well as low mortality. For these reasons surgery should be discussed early in the disease if pain becomes a major problem. If these patients are operated prior to analgesia addiction, maybe the long-term prognosis will improve. The diagnostic and surgical approach will be discussed in detail with a plea for considering surgery early in the course of disease.

ISSN:0257-2753    

DOI:10.1159/000171375

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Patients with proved necrotizing pancreatitis should be treated in an intensive care unit. Surgical management of necrotizing pancreatitis is indicated if an acute abdomen or persistent or increasing signs of organ complications develop, such as pulmonary or renal insufficiency, cardiocirculatory dysfunction or metabolic disorders, and these do not respond to maximum intensive care treatment over at least 72 h. Besides these so-called non-responders to ICU treatment, operative management is clearly indicated in patients who develop signs of sepsis on the basis of a bacteriologically positive fine-needle aspiration of pancreatic necroses. In patients with minor necroses without any bacterial contamination and without extensive retroperitoneal fatty tissue necroses intensive care therapy can be successful without the necessity of a surgical intervention. The gold standard of surgical management of necrotizing pancreatitis is careful removal of necrotic tissue, drainage of bacterially infected area, elimination of the pancreatogenic ascites in order to prevent systemic spread of vasoactive and toxic substances and interruption of the inflammatory process. For the treatment of pancreatic necrosis we strongly support surgical debridement (necrosectomy), supplemented by postoperative closed continuous lavage of the lesser sac and the adjacent necrotic cavities. In 152 patients suffering from severe necrotizing pancreatitis the hospital mortality was 12.5 % (19/152) by this surgical approach.

ISSN:0257-2753    

DOI:10.1159/000171376

出版商:S. Karger AG    

年代:1992

数据来源: Karger

ISSN:0257-2753    

DOI:10.1159/000171377

出版商:S. Karger AG    

年代:1992

数据来源: Karger