Duodenum-preserving head resection in chronic pancreatitis changes the natural course of the disease: a single-center 26-year experience.

摘要: Chronic pancreatitis (CP) is characterized by the presence of chronic inflammatory lesions, destruction exocrine and endocrine parenchyma, fibrosis. 1 The molecular pathobiochemical mechanisms resulting in focal inflammation fibrosis pancreas are largely unknown. A common feature histologically infiltration leukocytes, 2 pancreatic main duct side branch alterations, necrosis, 3 extended 4 Leukocytes release cytokines growth factors (e.g., IL-1, IL-6, TNFα, EGFβ), which thought to induce proliferation mesenchymal cells. 5–7 Overexpression EGF TGFα+β acid basic FGF observed. 8–11 Activated cytotoxic cells their mediators considered play a key role process. 12–14 Upper abdominal pain, leading clinical symptom, related an increase tissue pressure pancreas. 15 Pathomorphologic changes sensory nerves, nerve diameter perineural cells, 16 neurotransmitter substance P calcitonin gene-related peptide be causally pain syndrome CP. 17,18 significant correlation was found between factor (NGF) mRNA expression amount fibrosis, as well degree acinar cell destruction; TrkA transmembranous thyrosinkinase receptor, binding NGF, intensity correlated. 19 increased activity NGF/TrkA signal cascade suggests pathway involved 19 On long-term follow-up, natural course CP reveals persistence 85% 55% patients 5 10 years after diagnosis. 20 progression insufficiency, frequently observed CP, has limited influence on syndrome. Local complications such pseudocystic lesion, bile stenosis, mass head, compression anatomic structures surrounding head frequently. Long-term follow-up that with have 5-year survival rate 67% 10-year 43%. 21,22 death 12% 20%. 22–24 Epidemiologic studies demonstrated coincidence cancer 1.8% 4% extrapancreatic cancers 3.9% 13%. 25–28 In Western countries, alcohol most frequent etiologic factor. Patients alcoholic severe local complications. subgroup consists predominantly men younger than 40; they usually finally resistant analgesic treatment, frequent. These candidates for surgical treatment. 28 In this article, we present preoperative early postoperative data 504 who underwent surgery Duodenum-preserving resection (DPPHR) used because it eradicates eliminates contribute