Zusammenfassung
Da die chronische Pankreatitis nicht kausal, sondern nur
symptomatisch zu therapieren ist, verlangt sie eine interdisziplinäre
Behandlung. Die Patienten benötigen häufig eine medikamentöse
Therapie. Relevante Gangobstruktionen, symptomatische Pseudozysten,
Pankreaskopftumoren und therapieresistente Schmerzen erfordern häufig den
Einsatz chirurgischer Verfahren. Die chrirugische Therapie kann Beschwerden und
Lebensqualität bei der chronischen Pankreatitis verbessern und die
Vorraussetzung für eine sozio-ökonomische Rehabilitation schaffen.
Zusätzlich senkt der Eingriff langfristig die Hospitalkosten. Da in bis zu
30 % der Fälle ein Malignom diagnostisch nicht sicher
auszuschließen ist, muss im Zweifel eine Resektion nach onkologischen
Kriterien durchgeführt werden.
Abstract
As there is no causal therapy, treatment of chronic pancreatitis
must be interdisciplinary. Patients often need a complex medication. Relevant
obstructions of the duct, symptomatic pseudocysts, tumor masses of the
pancreatic head and therapy-resistant pain frequently require surgical
intervention. Surgical therapy can better medical condition and afford good
conditions for social rehabilitation. In addition disease-specific costs
decrease on long term. As there is a diagnostic failure up to
30 % excluding a malignant disease an oncologic resection is
indicated in case of doubt.
Literatur
- 1
Adam U, Makowiec F, Riediger H, Benz S, Liebe S, Hopt U T.
Pankreasleckage nach Pankreasresektion. Eine Analyse von 345
operierten
Patienten.
Chirurg.
2002;
73
466-473
- 2
Baron T H, Harewood G C, Morgan D E, Yates M R.
Outcome differences after endoscopic drainage of pancreatic
necrosis, acute pancreatic pseodocysts and chronic pancreatic
pseudocysts.
Gastrointest
Endosc.
2002;
56
7-17
- 3
Bednarz W, Olewinski R.
The influence of chronic pancreatitis on carcinogenesis: an
experimental study in rats.
Eur J Gastroenterol
Hepatol.
2002;
14
671-677
- 4
Beger H G, Schlosser W, Friess H M, Büchler M W.
Duodenum-preserving head resection in chronic pancreatitis
changes natural course of the disease: a single-center 26-year
experience.
Ann
Surg.
1999;
230
512-519
- 5
Byrne R L, Gompertz R H, Venables C W.
Surgery for chronic pancreatitis: a review of 12 years
experience.
Ann R Coll Surg
Engl.
1997;
79
405-409
- 6
De Palma G D, Galloro G, Puzziello A, Mansone S, Persico G.
Endoscopic drainage of pancreatic pseudocysts: a long-term
follow-up study of 49
patients.
Hepatogastroenterology.
2002;
49
1113-1115
- 7
Evans J D, Wilson P G, Carver. et al .
Outcome of surgery for chronic pancreatitis.
Br J
Surg.
1997;
84
624-629
- 8
Howard T J, Jones J W, Sherman S, Fogel E, Lehman G A.
Impact of pancreatic head resection on direct medical costs
in patients with chronic pancreatitis.
Ann
Surg.
2001;
234
661-667
- 9
Hruban R H, Goggins M, Parson J, Kern S E.
Progression model for pancreatic cancer.
Clin
Cancer
Res.
1999;
6
2969-2972
- 10
Hutchins R R, Hart R S, Pacifico M, Bradley N J, Williamson R C.
Long-term results of distal pancreatectomy for chronic
pancreatitis in 90 patients.
Ann
Surg.
2002;
236
612-618
- 11
Ikenberry S O, Sherman S, Hawwes R H, Smith M, Lehman G A.
The occlusion rate of pancreatic
stents.
Gastrointest
Endosc.
1994;
40
611-613
- 12
Kinoshita H, Hara M, Hashimoto M. et al .
Surgical treatment for chronic pancreatitis: results of
pancreatic duct drainage operation and pancreatic resection.
Kurume
Med
J.
2002;
49
41-46
- 13
Kozarek R A, Ball T J, Patterson D J, Brandabur J J, Traverso L W, Raltz S.
Endoscopic pancreatic duct sphincterotomy: indications,
technique, and analysis of results.
Gastrointest
Endosc.
1994;
40
592-598
- 14 Lankisch P G. Natural course of chronic pancreatitis. New York:
de Gruyter In: Izbicki JR, Binmoeller KF, Soehendra N,
editors. Chronic Pancreatitis. An interdisciplinary
approach 1997: 1-15
- 15
Lankisch P G, Assmus C, Maisonneuve P, Lowenfels A B.
Epidemiology of pancreatic diseases in Luneburg County. A
study in a defined german
population.
Pancreatology.
2002;
2
469-477
- 16
Lowenfels A B, Maisonneuve P.
Epidemiologic and etiologic factors of pancreatic
cancer.
Hematol Oncol Clin
North.
2002;
16
1-16
- 17
Malka D, Hammel P, Maire F, Rufat P, Madeira I, Pessione F, Levy P, Ruszniewski P.
Risk of pancreatic adenocarcinoma in chronic
pancreatitis.
Gut.
2002;
51
849-852
- 18
Olah A, Belagyi T, Issekutz A.
Surgical aspects of histologically unproven space-occupying
lesions of the pancreas hea.
uctus Magy
Seb.
2002;
55
24-26
- 19
Sakorafas G H, Farnell M B, Nagorney D M, Sarr M G, Rowland C M.
Pancreatoduodenectomy for chronic pancreatitis in 105
patients.
Arch
Surg.
2000;
135
517-523
- 20
Sakorafas G H, Sarr M G.
Changing trends in operations for chronic pancreatitis: A
22-year experience.
Eur J
Surg.
2000;
166
633-637
- 21
Schäfer M, Müllhaupt B, Clavien P A.
Evidence-based pancreatic head resection für pancreatic
cancer and chronic pancreatitis.
Ann
Surg.
2002;
236
137-148
- 22
Sohn T A, Campbell K A, Pitt H A. et al .
Quality of life and long-term survival after surgery for
chronic pancreatitis.
J Gastrointest
Surg.
2000;
4
355-364
- 23
Tinto A, Lloyd D A, Kang J Y. et al .
Acute and chronic pancreatitis - diseases on the rise:
a study of hospital admissions in England
1989/90 - 1999/2000.
Aliment Pharmacol
Ther.
2002;
16
2097-2105
- 24
Traverso L W, Kozarek R A.
Pancreatectoduodenectomy for chronic pancreatitis: anatomic
selection criteria and subsequent long-term outcome analysis.
Ann
Surg.
1997;
226
429-435
- 25
Usatoff V, Brancatisamo R, Williamson R C.
Operative treatment of pseudocysts in patinets with chronic
pancreatitis.
Br J
Surg.
2000;
87
1494-1499
- 26
Yamaguchi K, Yokohata K, Nakano K. et al .
Which is less invasive pancreatic head resection: PD, PPPD,
or DPPHR?.
Dig Dis
Sci.
2001;
46
282-288
Dr. med. Carsten Johannes Krones
Chirurgische Universitäts- und Poliklinik der RWTH
Aachen
Pauwelstraße 30
52074 Aachen
Phone: 0241/8089501
Fax: 0241/8082417
Email: Carsten.Krones@post.rwth-aachen.de