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Chronische Pankreatitis

Operationsindikation und -verfahren

Chronic pancreatitis

Operation indications and procedures

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Zusammenfassung

Die Folgen der chronischen Pankreatitis sind therapierefraktäre Schmerzen, Gangobstruktionen, Duodenalstenose oder Gefäßkompressionen. Die chirurgische Therapie kann diese Folgen effektiv behandeln. Endoskopische Therapieansätze sind prinzipiell möglich, bieten aber keine langfristigen Erfolgsaussichten. Die Auswahl des Operationsverfahrens orientiert sich an den morphologischen Veränderungen. Bei fast 90 % der Patienten liegt ein entzündlich vergrößerter Pankreaskopf vor. Hier wird die duodenumerhaltende Pankreaskopfresektion (DEPKR) nach Beger, Frey oder die Berner Modifikation bevorzugt. Die Verfahren sind hinsichtlich der postoperativen Ergebnisse nahezu gleichwertig. Die Kausch-Whipple-Operation ist bei Verdacht auf ein Malignom indiziert. In der Behandlung des entzündlichen Kopftumors hat die DEPKR nach aktueller Datenlage kurz- und mittelfristig Vorteile gegenüber der Kausch-Whipple-Operation. Drainageverfahren kommen bei Pseudozysten oder bei der seltenen Konstellation einer reinen Gangobstruktion zum Einsatz. In der Auswahl des geeigneten Verfahrens ist die interdisziplinäre Zusammenarbeit zwischen Gastroenterologen und Chirurgen wichtig.

Abstract

Chronic pancreatitis can lead to intractable pain, pancreatic duct obstruction, duodenal stenosis and vascular compression syndromes. Surgical interventions can effectively treat these symptoms. Endoscopic procedures are principally possible but rarely lead to a lasting relief of symptoms. The type of surgical intervention should be selected depending on the morphological changes of the pancreas. Up to 90 % of patients present with an inflammatory mass in the head of the pancreas. In these cases a duodenum-preserving pancreatic head resection (DPPHR) modified according to Beger, Frey or Berne should be preferred. These procedures are comparable in terms of the postoperative course. The Kausch-Whipple procedure is indicated in all cases where malignancy is suspected. According to the current literature, patients with an inflammatory mass in the pancreatic head benefit more from a DPPHR than a Kausch-Whipple procedure. Drainage procedures may be useful for the treatment of pseudocysts or in rare situations with purely ductal obstructions. The decision as to which procedure is appropriate should be taken in an interdisciplinary cooperation between gastroenterologists and surgeons.

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Literatur

  1. Gress TM, Muller-Pillasch F, Lerch MM et al (1994) Balance of expression of genes coding for extracellular matrix proteins and extracellular matrix degrading proteases in chronic pancreatitis. Z Gastroenterol 32:221–225

    CAS  PubMed  Google Scholar 

  2. Lerch MM, Bachmann KA, Izbicki JR (2013) New guidelines on chronic pancreatitis: interdisciplinary treatment strategies. Chirurg 84:99–105

    Article  CAS  PubMed  Google Scholar 

  3. Lin Y, Tamakoshi A, Hayakawa T et al (2001) Associations of alcohol drinking and nutrient intake with chronic pancreatitis: findings from a case-control study in Japan. Am J Gastroenterol 96:2622–2627

    Article  CAS  PubMed  Google Scholar 

  4. Jacob JJ, John M, Thomas N et al (2006) Does hyperparathyroidism cause pancreatitis? A South Indian experience and a review of published work. ANZ J Surg 76:740–744

    Article  PubMed  Google Scholar 

  5. Hoffmeister A, Mayerle J, Dathe K et al (2012) Method report to the S3 guideline chronic pancreatitis: definition, etiology, diagnostics and conservative, interventional endoscopic and surgical therapy of the chronic pancreatitis. Z Gastroenterol 50:1225–1236

    Article  CAS  PubMed  Google Scholar 

  6. Maisonneuve P, Lowenfels AB, Mullhaupt B et al (2005) Cigarette smoking accelerates progression of alcoholic chronic pancreatitis. Gut 54:510–514

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Keller J, Layer P (2005) Human pancreatic exocrine response to nutrients in health and disease. Gut 54(Suppl 6):1–28

    Article  PubMed Central  Google Scholar 

  8. Talamini G, Falconi M, Bassi C et al (2001) Previous cholecystectomy, gastrectomy, and diabetes mellitus are not crucial risk factors for pancreatic cancer in patients with chronic pancreatitis. Pancreas 23:364–367

    Article  CAS  PubMed  Google Scholar 

  9. Catalano MF, Sahai A, Levy M et al (2009) EUS-based criteria for the diagnosis of chronic pancreatitis: the Rosemont classification. Gastrointest Endosc 69:1251–1261

    Article  PubMed  Google Scholar 

  10. Cahen DL, Gouma DJ, Laramee P et al (2011) Long-term outcomes of endoscopic vs surgical drainage of the pancreatic duct in patients with chronic pancreatitis. Gastroenterology 141:1690–1695

    Article  PubMed  Google Scholar 

  11. Cahen DL, Gouma DJ, Nio Y et al (2007) Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis. N Engl J Med 356:676–684

    Article  CAS  PubMed  Google Scholar 

  12. Dite P, Ruzicka M, Zboril V et al (2003) A prospective, randomized trial comparing endoscopic and surgical therapy for chronic pancreatitis. Endoscopy 35:553–558

    Article  CAS  PubMed  Google Scholar 

  13. Kahl S, Zimmermann S, Genz I et al (2003) Risk factors for failure of endoscopic stenting of biliary strictures in chronic pancreatitis: a prospective follow-up study. Am J Gastroenterol 98:2448–2453

    Article  PubMed  Google Scholar 

  14. Bloechle C, Izbicki JR, Knoefel WT et al (1995) Quality of life in chronic pancreatitis – results after duodenum-preserving resection of the head of the pancreas. Pancreas 11:77–85

    Article  CAS  PubMed  Google Scholar 

  15. Izbicki JR, Bloechle C, Broering DC et al (1998) Extended drainage versus resection in surgery for chronic pancreatitis: a prospective randomized trial comparing the longitudinal pancreaticojejunostomy combined with local pancreatic head excision with the pylorus-preserving pancreatoduodenectomy. Ann Surg 228:771–779

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Koninger J, Seiler CM, Sauerland S et al (2008) Duodenum-preserving pancreatic head resection – a randomized controlled trial comparing the original Beger procedure with the Berne modification (ISRCTN No. 50638764). Surgery 143:490–498

    Article  PubMed  Google Scholar 

  17. Izbicki JR, Bloechle C, Knoefel WT et al (1997) Drainage versus resection in surgical therapy of chronic pancreatitis of the head of the pancreas: a randomized study. Chirurg 68:369–377

    Article  CAS  PubMed  Google Scholar 

  18. Muller MW, Friess H, Martin DJ et al (2008) Long-term follow-up of a randomized clinical trial comparing Beger with pylorus-preserving Whipple procedure for chronic pancreatitis. Br J Surg 95:350–356

    Article  CAS  PubMed  Google Scholar 

  19. Diener MK, Bruckner T, Contin P et al (2010) ChroPac-trial: duodenum-preserving pancreatic head resection versus pancreatoduodenectomy for chronic pancreatitis. Trial protocol of a randomised controlled multicentre trial. Trials 11:47

    Article  PubMed Central  PubMed  Google Scholar 

  20. Buchler MW, Warshaw AL (2008) Resection versus drainage in treatment of chronic pancreatitis. Gastroenterology 134:1605–1607

    Article  PubMed  Google Scholar 

  21. Schneider CG, Cataldegirmen G, Mann O et al (2009) Laterale Anastomosentechniken. Chirurg 80:28–33

    Article  CAS  PubMed  Google Scholar 

  22. Strobel O, Büchler MW, Werner J (2009) Duodenumerhaltende Pankreaskopfresektion. Chirurg 80:22–27

    Article  CAS  PubMed  Google Scholar 

  23. Puestow CB, Gillesby WJ (1958) Retrograde surgical drainage of pancreas for chronic relapsing pancreatitis. AMA Arch Surg 76:898–907

    Article  CAS  PubMed  Google Scholar 

  24. Partington PF, Rochelle RE (1960) Modified Puestow procedure for retrograde drainage of the pancreatic duct. Ann Surg 152:1037–1043

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. Lerch MM, Stier A, Wahnschaffe U et al (2009) Pancreatic pseudocysts: observation, endoscopic drainage, or resection? Dtsch Arztebl Int 106:614–621

    PubMed Central  PubMed  Google Scholar 

  26. Bradley EL, Clements JL Jr, Gonzalez AC (1979) The natural history of pancreatic pseudocysts: a unified concept of management. Am J Surg 137:135–141

    Article  CAS  PubMed  Google Scholar 

  27. Trede M (1994) The Whipple technique of duodenopancreatectomy. Chirurg 65:232–240

    CAS  PubMed  Google Scholar 

  28. Weitz J, Koch M, Kleeff J et al (2004) Kausch-Whipple pancreaticoduodenectomy. Technique and results. Chirurg 75:1113–1119

    Article  CAS  PubMed  Google Scholar 

  29. Beger HG, Buchler M, Bittner RR et al (1989) Duodenum-preserving resection of the head of the pancreas in severe chronic pancreatitis. Early and late results. Ann Surg 209:273–278

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  30. Strate T, Taherpour Z, Bloechle C et al (2005) Long-term follow-up of a randomized trial comparing the beger and frey procedures for patients suffering from chronic pancreatitis. Ann Surg 241:591–598

    Article  PubMed Central  PubMed  Google Scholar 

  31. Frey CF, Amikura K (1994) Local resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy in the management of patients with chronic pancreatitis. Ann Surg 220:492–504

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  32. Gloor B, Friess H, Uhl W et al (2001) A modified technique of the Beger and Frey procedure in patients with chronic pancreatitis. Dig Surg 18:21–25

    Article  CAS  PubMed  Google Scholar 

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Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Niedergethmann, O. Nephuth und T. Hasenberg geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Alfried Krupp Krankenhaus, Klinik für Allgemein- und Viszeralchirurgie, Alfried-Krupp-Str. 21, 45131, Essen, Deutschland

    M. Niedergethmann, O. Nephuth & T. Hasenberg

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  1. M. Niedergethmann
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  2. O. Nephuth
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  3. T. Hasenberg
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Correspondence to M. Niedergethmann.

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Niedergethmann, M., Nephuth, O. & Hasenberg, T. Chronische Pankreatitis. Chirurg 85, 1123–1134 (2014). https://doi.org/10.1007/s00104-014-2871-2

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