Przemysl Chemiczny最新文献

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Chronic pancreatitis for the clinician: complications and special forms of the disease. Interdisciplinary position paper of the Catalan Society of Digestology (SCD) and the Catalan Pancreatic Society (SCPanc). 临床医生的慢性胰腺炎。并发症和特殊形式的疾病。加泰罗尼亚消化学会（SCD）和加泰罗尼亚胰腺学会（SCPanc）的跨学科立场文件。

IF 3 4区工程技术 Q4 CHEMISTRY, MULTIDISCIPLINARY

Przemysl Chemiczny

Pub Date : 2024-06-01 Epub Date: 2022-03-08 DOI: 10.23736/S2724-5985.22.03127-8

Xavier Molero, Juan R Ayuso, Joaquim Balsells, Jaume Boadas, Juli Busquets, Anna Casteràs, Mar Concepción, Míriam Cuatrecasas, Gloria Fernàndez Esparrach, Esther Fort, Francisco Garcia Borobia, Àngels Ginès, Lucas Ilzarbe, Carme Loras, Miquel Masachs, Xavier Merino, Jorge J Olsina, Valentí Puig-Diví, Sílvia Salord, Teresa Serrano, Eva C Vaquero

Chronic pancreatitis tends to develop a number of complications that may constitute the form of presentation of the disease. Some societies have issued guidelines for diagnosis and treatment of chronic pancreatitis complications, but the level of evidence for any topic is usually low and recommendations tend to be weak. We aimed to provide defined position statements for the clinician based on updated review of published literature and on multidisciplinary expert agreement. The goal was to propose defined terminology and rational diagnostic/therapeutic circuits based on current knowledge. To this end 14 sections related to complications and special forms of chronic pancreatitis (early chronic, groove and autoimmune pancreatitis) were reviewed by 21 specialists from 6 different fields to generate 32 statements. Featured statements assert common bile duct stenosis does not require invasive treatment (endoscopic or surgical) unless cholestasis, cholangitis, lithiasis or other symptoms develop. Pancreatic duct strictures and calculi should be approached (after ruling out malignancy) if causing pain, pancreatitis, pseudocysts or other complications. Treatment of symptomatic pseudocysts must be individualized, considering associated main duct stenosis, vascular and pericystic complications. Higher risk conditions for pancreatic cancer are advance age, smoking, genetic background, recent diagnosis of chronic pancreatitis or diabetes, and appearance of new symptoms. Groove pancreatitis can initially be treated with conservative measures. Both prednisolone or rituximab can induce remission and maintenance of autoimmune pancreatitis. Internal fistula, vascular complications, bacterial overgrowth, osteoporosis and renal lithiasis require specific therapeutic approaches.

慢性胰腺炎往往会出现一些并发症，这些并发症可能构成疾病的表现形式。一些学会已经发布了慢性胰腺炎并发症的诊断和治疗指南，但任何主题的证据水平通常都很低，建议也往往很薄弱。我们的目标是根据对已发表文献的最新回顾和多学科专家的一致意见，为临床医生提供明确的立场声明。我们的目标是在现有知识的基础上，提出明确的术语和合理的诊断/治疗方案。为此，来自 6 个不同领域的 21 位专家对与并发症和特殊形式的慢性胰腺炎（早期慢性胰腺炎、槽沟胰腺炎和自身免疫性胰腺炎）相关的 14 个章节进行了审查，最终形成了 32 项声明。特色声明认为，除非出现胆汁淤积、胆管炎、胆石症或其他症状，否则总胆管狭窄不需要进行侵入性治疗（内镜或手术）。如果胰管狭窄和结石引起疼痛、胰腺炎、假性囊肿或其他并发症，则应进行治疗（在排除恶性肿瘤后）。无症状假性囊肿的治疗必须因人而异，考虑相关的主导管狭窄、血管和囊肿周围并发症。胰腺癌的高危因素包括高龄、吸烟、遗传背景、近期诊断出慢性胰腺炎或糖尿病以及出现新症状。沟状胰腺炎最初可采用保守治疗。泼尼松龙或利妥昔单抗均可诱导自身免疫性胰腺炎缓解和维持。内瘘、血管并发症、细菌过度生长、骨质疏松症和肾结石需要特殊的治疗方法。

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