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慢性胰腺炎的治疗

Author
Steven D Freedman, MD, PhD
Section Editor
David C Whitcomb, MD, PhD
Deputy Editor
Shilpa Grover, MD, MPH, AGAF

引言

慢性胰腺炎通常表现为慢性持续性疼痛，伴阵发性加重。虽然不时有言论称慢性胰腺炎会随着时间的推移而“消失”，但如果其确实发生，慢性胰腺炎持续的时间也存在很大变数[1-4]。此外，随着疾病的进展，可能出现胰腺内分泌和外分泌功能障碍，也可发生多种并发症，包括假性囊肿、胆管或十二指肠梗阻、胰源性腹水、脾静脉血栓形成和假性动脉瘤。

因此，慢性胰腺炎的自然病程相对不乐观。大多数疗法旨在通过尽可能减少胰腺外分泌而使胰腺“休眠”；不幸的是，这种做法相对无效。治疗的目标包括疼痛管理、纠正胰腺功能不全和治疗并发症[5]。获得性胰腺炎患者和遗传性胰腺炎患者的治疗相似。

慢性胰腺炎(主要是疼痛和胰腺外分泌功能不全)的治疗将总结在此。慢性胰腺炎的其他并发症及其治疗、病因、临床表现和诊断将单独讨论。 (参见“慢性胰腺炎的并发症”和“成人慢性胰腺炎的病因和发病机制”和“儿童和青少年慢性胰腺炎的病因”和“成人慢性胰腺炎的临床表现和诊断”和“儿童慢性胰腺炎的临床表现和诊断”)

确立可靠的诊断

当疼痛性质出现显著变化或持续性症状突然发作时，应排除其他潜在病因(如消化性溃疡病、胆道梗阻、假性囊肿、胰腺癌和胰管狭窄或结石)。确立慢性胰腺炎的诊断是很困难的，特别是在疾病的最初2-3年，此时大多数诊断检查结果都可为正常。 (参见“成人慢性胰腺炎的临床表现和诊断”和“儿童慢性胰腺炎的临床表现和诊断”)

疼痛治疗

慢性胰腺炎的主要症状是腹痛。疼痛可能介于偶尔餐后不适至伴有恶心、呕吐和体重减轻的致人衰弱的持续性疼痛之间。疼痛治疗在某些情况下难以实现。但是，考虑缓解疼痛的适当方式时，应认识到在大多数研究中，单独应用安慰剂对多达30%的患者是有效的。

                        

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Literature review current through: 2017-06 . | This topic last updated: 2016-10-24.
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