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目的 前瞻性研究内镜治疗慢性胰腺炎(CP)的长期疗效.方法 根据M-ANNHEIM分类系统的CP诊断标准,将纳入的CP患者进行内镜治疗,包括内镜下行十二指肠乳头括约肌切开或胰管括约肌切开、胰管取石、胰管狭窄扩张、胰管支架放置,对患者治疗前后急性胰腺炎发作次数、腹痛、体重、内外分泌功能、胰管最大直径的变化情况进行分析.结果 2006年1月1日至2007年12月31日共入选107例诊断明确的CP患者,男74例,女33例,平均年龄41.2岁,成功随访105例,失访2例,平均随访时间为15(3～27)个月,其中有4例转外科手术治疗,余101例患者腹痛完全缓解和部分缓解的分别有70例和19例,腹痛缓解率为88.1%(89/101);内镜治疗前后糖尿病患者数均为10例,脂肪泻患者数分别为10例和3例;内镜治疗后有56.4%(57/101)的患者体重增加,平均增加4 kg;内镜治疗前后胰管直径无显著变化,胰管直径的变化和内镜疗效无明显联系.结论 内镜治疗可缓解CP的腹痛症状,增加患者体重.

Objective To investigate the long-term effect of endoscopic management of chronic pan-creatitis(CP) prospectively. Methods Based on the M-ANNHEIM diagnostic criteria of CP, the patients with CP were treated with endoscopic procedures, including papillotomy or pancreatic sphincterotomy, calcu-Ins removal, stonosis dilation and stent insertion. Pre-and post-operative incidence of acute pancreatitis (AP), abdominal pain, weight, endocrine and exocrine functions and change of pancreatic duct diameter were analyzed. Results From January 1,2006 to December 31,2007, a total of 107 patients with CP, in-cluding 74 males and 33 females, with a mean age of 41.2 years at admission, were recruited. All patients except 2 lost ones were followed up at a mean duration of 15 months (3-27 months). During the follow-up, 4 patients received surgery. Abdominal pain was completely resolved in 70 patients and partly resolved in 19 patients, with a total remission rate at 88. 1%. Insufficient endocrine funetion presented as diabetes was de-tooted in 10 patients before the treatment and no improvement was observed during the follow-up. Steatorrhea was presented in 10 patients and was resolved in 7 after the treatments. Weight gain at an average of 4 kg was achieved in 56. 4% (57/101) of the patients. No significant change in diameter of pancreatic duct was observed before and after the endoscopic procedure, which was not correlated with patient outcome. Conclusion Endoscopic managements can relieve abdominal pain and increase body weight in patients with CP.