Chronische Pankreatitis – ein Update aus Sicht des Chirurgen

Zusammenfassung

Die enorme sozioökonomische Auswirkung der chronischen Pankreatitis lässt sich durch stetig steigende Inzidenz und Prävalenz, häufige Hospitalisierungen, Entwicklung von Opiatabhängigkeit und vorzeitige Verrentung von jungen Menschen eindeutig demonstrieren. Ziele der Therapie sind die frühestmögliche Schmerzbefreiung mit Verbesserung der Lebensqualität, Beseitigung von Komplikationen und Karzinomvorbeugung unter maximalem Funktionserhalt. Da die konservative Behandlung alleine langfristig weitestgehend ineffektiv ist, spielt die chirurgische Therapie eine zentrale Rolle und sollte möglichst frühzeitig eingesetzt werden. Das Spektrum der operativen Verfahren ist sehr breit und umfasst reine Drainageeingriffe, klassische resektive Verfahren und parenchymschonende Hybridtechniken. Die Wahl des optimalen therapeutischen Managements sollte die konkreten pathomorphologischen Besonderheiten bei jedem individuellen Patienten berücksichtigen und wenn möglich an spezialisierten Pankreaszentren erfolgen. Diese Übersichtsarbeit präsentiert den aktuellen evidenzbasierten Wissensstand über die chronische Pankreatitis aus chirurgischer Sicht. Eine praxisorientierte Zusammenfassung der therapeutischen Strategien wird entsprechend der gültigen Leitlinien unter Berücksichtigung der neuesten Erkenntnisse aus der Literatur dargestellt.

Abstract

Continuously rising incidence and prevalence, frequent hospitalisation, development of opioid dependence, and early retirement of young people demonstrate the enormous socioeconomic impact of chronic pancreatitis. The aims of therapy include pain relief, improved quality of life, management of complications, cancer prevention and preservation of function. Since medical and endoscopic approaches of conservative therapy have proved to be ineffective in the long term, surgery remains the mainstay of treatment and should be considered as early as possible. Surgery encompasses a wide spectrum of methods, ranging from simple drainage procedures and conventional resections to various hybrid techniques. The choice of optimal surgical management should consider the unique pathomorphologic changes of each patient and be performed at a high-volume pancreas centre. This review presents the current evidence-based state of knowledge about chronic pancreatitis from a surgical point of view with a practical summary of therapeutic strategies according to the available guidelines and considering the most recent literature.

Schlüsselwörter

chronische Pankreatitis - exokrine Pankreasinsuffizienz - pankreopriver Diabetes mellitus - duodenumerhaltende Pankreaskopfresektion - Duodenohemipankreatektomie - chronisches Schmerzsyndrom

Key words

chronic pancreatitis - chronic pain - exocrine insufficiency - diabetes - duodenum-preserving pancreatic head resection - pancreaticoduodenectomy

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