Title: Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis.
Author:Cahen DL, Gouma DJ, Nio Y, Rauws EA, Boermeester MA, Busch OR, Stoker J, Lameris JS, Dijkgraaf MG, Huibregtse K, Bruno MJ.
Resource:N Engl J Med. 2007 Feb 15;356(7):676-84
Abstract: BACKGROUND: For patients with chronic pancreatitis and a dilated pancreatic duct, ductal decompression is recommended. We conducted a randomized trial to compare endoscopic and surgical drainage of the pancreatic duct. METHODS: All symptomatic patients with chronic pancreatitis and a distal obstruction of the pancreatic duct but without an inflammatory mass were eligible for the study. We randomly assigned patients to undergo endoscopic transampullary drainage of the pancreatic duct or operative pancreaticojejunostomy. The primary end point was the average Izbicki pain score during 2 years of follow-up. The secondary end points were pain relief at the end of follow-up, physical and mental health, morbidity, mortality, length of hospital stay, number of procedures undergone, and changes in pancreatic function. RESULTS: Thirty-nine patients underwent randomization: 19 to endoscopic treatment (16 of whom underwent lithotripsy) and 20 to operative pancreaticojejunostomy. During the 24 months of follow-up, patients who underwent surgery, as compared with those who were treated endoscopically, had lower Izbicki pain scores (25 vs. 51, P<0.001) and better physical health summary scores on the Medical Outcomes Study 36-Item Short-Form General Health Survey questionnaire (P=0.003). At the end of follow-up, complete or partial pain relief was achieved in 32% of patients assigned to endoscopic drainage as compared with 75% of patients assigned to surgical drainage (P=0.007). Rates of complications, length of hospital stay, and changes in pancreatic function were similar in the two treatment groups, but patients receiving endoscopic treatment required more procedures than did patients in the surgery group (a median of eight vs. three, P<0.001). CONCLUSIONS: Surgical drainage of the pancreatic duct was more effective than endoscopic treatment in patients with obstruction of the pancreatic duct due to chronic pancreatitis.
PMID:17301298
Title: Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis.
题目：慢性胰腺炎内镜或外科引流治疗的对比研究
Author:Cahen DL, Gouma DJ, Nio Y, Rauws EA, Boermeester MA, Busch OR, Stoker J, Lameris JS, Dijkgraaf MG, Huibregtse K, Bruno MJ.
作者：Cahen DL, Gouma DJ, Nio Y, Rauws EA, Boermeester MA, Busch OR, Stoker J, Lameris JS, Dijkgraaf MG, Huibregtse K, Bruno MJ.
Resource:N Engl J Med. 2007 Feb 15;356(7):676-84
来源：N Engl J Med. 2007 Feb 15;356(7):676-84
BACKGROUND: For patients with chronic pancreatitis and a dilated pancreatic duct, ductal decompression is recommended. We conducted a randomized trial to compare endoscopic and surgical drainage of the pancreatic duct.
背景：对于慢性胰腺炎合并胰管扩张的病人，胰管减压是被推荐的治疗方法。我们进行了一项随机试验对胰管扩张内镜和外科治疗进行了对比研究。
METHODS: All symptomatic patients with chronic pancreatitis and a distal obstruction of the pancreatic duct but without an inflammatory mass were eligible for the study. We randomly assigned patients to undergo endoscopic trans ampullary drainage of the pancreatic duct or operative pancreaticojejunostomy.
方法：有慢性胰腺炎以及胰管远端梗阻但不合并炎性肿块的有症状病人入选该研究。我们随机将病人分配致内镜下经壶腹部胰管引流组或外科胰管空肠吻合术组。
The primary end point was the average Izbicki pain score during 2 years of follow-up. The secondary end points were pain relief at the end of follow-up, physical and mental health, morbidity, mortality, length of hospital stay, number of procedures undergone, and changes in pancreatic function.
初级终点为2年随访的平均Izbicki疼痛积分。次级终点为随访结束时疼痛的缓解、生理和心理健康、发病率、死亡率、住院时间、所行操作次数、以及胰腺功能的变化。
RESULTS: Thirty-nine patients underwent randomization: 19 to endoscopic treatment (16 of whom underwent lithotripsy) and 20 to operative pancreaticojejunostomy. During the 24 months of follow-up, patients who underwent surgery, as compared with those who were treated endoscopically, had lower Izbicki pain scores (25 vs. 51, P<0.001) and better physical health summary scores on the Medical Outcomes Study 36-Item Short-Form General Health Survey questionnaire (P=0.003).
结果：39例完成随机试验：19例为内镜下治疗（其中16例行碎石术），20例行胰管空肠吻合术。在随后24个月的随访中，外科手术组较内镜治疗组的Izbicki疼痛积分更低（(25 比51, P<0.001)，且在关于医疗研究结果的36项短表格一般健康调查问卷表中获得更高的身体健康累计积分(P=0.003)。
At the end of follow-up, complete or partial pain relief was achieved in 32% of patients assigned to endoscopic drainage as compared with 75% of patients assigned to surgical drainage (P=0.007). Rates of complications, length of hospital stay, and changes in pancreatic function were similar in the two treatment groups, but patients receiving endoscopic treatment required more procedures than did patients in the surgery group (a median of eight vs. three, P<0.001).
在随访的终点，部分或完全疼痛缓解率在内镜引流组和外科引流组分别为32％和75％(P=0.007)。并发症发生率、住院时间和胰腺功能变化在两组间无明显差异，但内镜治疗组较外科治疗组患者需要更多治疗次数（平均为8：3，P<0.001）。
CONCLUSIONS: Surgical drainage of the pancreatic duct was more effective than endoscopic treatment in patients with obstruction of the pancreatic duct due to chronic pancreatitis.
结论：对于慢性胰腺炎合并胰管梗阻病人胰管外科引流术较内镜治疗更有效。
编译后
题目：慢性胰腺炎内镜或外科引流治疗的对比研究
作者：Cahen DL, Gouma DJ, Nio Y, Rauws EA, Boermeester MA, Busch OR, Stoker J, Lameris JS, Dijkgraaf MG, Huibregtse K, Bruno MJ.
来源：N Engl J Med. 2007 Feb 15;356(7):676-84
背景：对于慢性胰腺炎合并胰管扩张的病人，胰管减压是被推荐的治疗方法。我们进行了一项随机试验对胰管扩张内镜和外科治疗进行了对比研究。
方法：有慢性胰腺炎以及胰管远端梗阻但不合并炎性肿块的有症状病人入选该研究。我们随机将病人分配致内镜下经壶腹部胰管引流组或外科胰管空肠吻合术组。初级终点为2年随访的平均Izbicki疼痛积分。次级终点为随访结束时疼痛的缓解、生理和心理健康、发病率、死亡率、住院时间、所行操作次数、以及胰腺功能的变化。
结果：39例完成随机试验：19例为内镜下治疗（其中16例行碎石术），20例行胰管空肠吻合术。在随后24个月的随访中，外科手术组较内镜治疗组的Izbicki疼痛积分更低（(25 比51, P<0.001)，且在关于医疗研究结果的36项短表格一般健康调查问卷表中获得更高的身体健康累计积分(P=0.003)。在随访的终点，部分或完全疼痛缓解率在内镜引流组和外科引流组分别为32％和75％(P=0.007)。并发症发生率、住院时间和胰腺功能变化在两组间无明显差异，但内镜治疗组较外科治疗组患者需要更多治疗次数（平均为8：3，P<0.001）。
结论：对于慢性胰腺炎合并胰管梗阻病人胰管外科引流术较内镜治疗更有效。
需要指出的是
该研究仅限在慢性胰腺炎合并胰管扩张的病人,而不是针对所有慢性胰腺炎病人.
