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慢性胰腺炎的临床表现包括疼痛、脂肪泻和糖尿病。在西方国家 ,慢性胰腺炎最常见的病因是酗酒。 70 %以上的病人在就诊时有疼痛的临床表现 ,而且 ,这些患者中又有 75 %以上会在几年之后出现疼痛减轻或完全消失。对于所有的慢性胰腺炎的病人来说 ,均应排除非胰源性疼痛和胆道梗阻、胰腺假性囊肿等胰腺局部并发症。应建议所有慢性胰腺炎病人戒烟、戒酒。阿片类镇痛剂仅应用于治疗疼痛严重的病人。尽管有报道认为胰酶替代治疗有助于止痛 ,但是 ,对于已经确诊的慢性胰腺炎病人来说 ,该疗法无效。激素类药物进行腹腔神经丛阻滞术可能有助于病人度过剧烈疼痛期。顽固性疼痛是进行胰液引流或胰腺切除的适应证。建议应用适量胰酶替代联合 (或不联合 )制酸剂治疗营养不良。慢性胰腺炎导致的糖尿病与原发性糖尿病的治疗原则相似。
Clinical manifestations of chronic pancreatitis include pain, steatorrhea and diabetes. In western countries, the most common cause of chronic pancreatitis is alcoholism. More than 70% of patients have clinical manifestations of pain at the time of their visit, and more than 75% of these patients will experience pain relief or complete disappearance after several years. For all patients with chronic pancreatitis, should be excluded non-pancreatic pain and biliary obstruction, pancreatic pseudocyst pancreas and other local complications. All patients with chronic pancreatitis should be advised to quit smoking and stop drinking. Opioid analgesics should only be used in patients with severe pain. Although it has been reported that trypsin replacement therapy can help relieve pain, this treatment is not effective in patients with established chronic pancreatitis. Hormonal blockade of celiac plexus may help patients with severe pain. Refractory pain is the indication of pancreatic drainage or pancreatic excision. It is recommended to use appropriate amount of trypsin instead of combining (or not) antacids to treat malnutrition. Diabetes caused by chronic pancreatitis and the principle of treatment of primary diabetes are similar.