The Clinical Analysis Of263Chronic Pancreatitis Cases According To The M-ANNHEIM Classification

Objective To retrospectively review and analyze the various etiology, clinical characteristics and treatment of263chronic pancreatitis patients according to the M-ANNHEIM classification system of chronic pancreatitis.To improve the understanding of the disease and get further reference for the diagnosis and treatment of CP.Methods The clinical data of263patients with chronic pancreatitis of Xiangya hospital from January2005to January2012were reviewed. The classification and analysis of them were performed according to the M-ANNHEIM system.Results1. The factor of chronic alcoholic poisoning was the primary cause of disease in the cases, making up of41.1%. The secondary factor was smoking and the disease of pancreatic duct and biliary, accounted respectively for28.1%and39.9%. The male patients were suffered from mainly alcoholic chronic pancreatitis and many female patients had chronic biliary pancreatitis. Among other factors, genetic factor (19.0%), hyperlipidemia (5.7%) and so on were included. Those patients with autoim-mune pancreatitis, hypercalcemia, hyperparathyroidism, chronic renal failure, drugs, toxins and other mixed rare factors were not observed in the group. While the patients with two risk factors accounted for13.3%(35cases); The patients with three risk factors accounted for2.3%(6cases).2. There were193cases (75.2%) with calcification of pancreas or pancreatic duct stones,66cases (25.1%) with diabetes,25cases (9.5%) with steatorrhea,35cases (13.3%) with pancreatic pseudocysts,28cases (10.6%) with biliary obstruction and8cases with pancreatic cancer. No pancreatic fistula was involved.3. M-ANNHEIM clinical staging of chronic pancreatitis:No case was in the stage0;202cases (76.8%) were in the stage Ⅰ;45cases (17.1%) were in the stage Ⅱ;15cases (15.9%) were in the stage Ⅲ; And only one case was in the stage Ⅳ. It was obvious that most cases were in the stage Ⅰ and Ⅱ. The M-ANNHEIM score and severity index:The mean point was8.6;65cases (24.7%) were at the minor level;187cases(71.1%) were at the increasing level; And9cases were at the advanced level. This showed that most cases were at the minor and increased level and only a few belonged to the marked and exacerbated level.4. Adult chronic pancreatitis groups:The pancreatic calcification incidence of the patients with excessive alcohol consumption (>80g/d) were significantly higher than that of non-drinking patients (84.3%VS66.9%)(P <0.05), and there was a significant difference between them; The diabetes and steatorrhea incidence of the patients with biliary disease were higher than that of non-drinking patients, but that was not significantly different; The smoking patients’incidence of pancreatic calcification were higher than non-smokers’, it was significantly different. The smoking patients’incidence of diabetes and steatorrhea were higher than non-smokers’, but that was not significantly different between them.5. There was no obvious difference between the pancreatic calcification incidence of the adolescent chronic pancreatitis patients and the adult chronic pancreatitis patients (P>0.05). However, the adolescent chronic pancreatitis patients’incidence of diabetes and complications were lower than the aulds’6. In these cases,134cases of the surgical treatment accounted for51%.there were65cases of the pancreatic duct decompress drainage,25cases of pancreatectomy,36cases of biliary surgery and eight cases of paunch to biopsy probe. The other129cases suffered conservative treatment. All cases were divided into two group with surgical treatment (95cases) and the conservative treatment group (92cases).In the follow-up after hospital discharge, in the group after surgical treatment abdominal complete pain response rate was58.9%,and in the group after conservative treatment complete pain response rate was42.4%(P<0.05). Two weeks after treatment we had scored the stage Ⅰ, Ⅱ and Ⅲ of cases respectively according to M-ANNHEIM score system, and found that the effection of surgical treatment was better than the one of conservative treatment. Conclusions1. In recent6years, the major risky factors of CP in our Hospital were alcohol, biliary system diseases and nicotine.And the alcohol had become the first resky factor.2. CP patients had the high incidence of pancreatic calcification (73.4%), and the pancreatic calcification was closely related to excessive alcohol consumption and smoking. Alcohol and smoking cessation was an important treatment of CP.3. The diabetes and complication incidence of adolescent CP patients was significantly lower than the one of adult CP patients.4. The effection of surgical treatment was better than Conservative treatment for Ⅰ or Ⅱ phase CP.And the surgical treatment remained the primary effective treatment of the CP.