慢性胰腺炎疼痛的机制及内镜治疗进展
收稿日期: 2025-06-23
网络出版日期: 2025-12-09
基金资助
无锡市第二届“双百”中青年医疗卫生拔尖人才项目(BJ2023031)
Progress in mechanism and endoscopic therapy on pain in chronic pancreatitis
Received date: 2025-06-23
Online published: 2025-12-09
慢性胰腺炎（CP）以上腹部疼痛为最常见的临床症状，严重影响生活质量并造成巨大的社会经济负担。CP腹痛机制涉及胰管高压、神经源性和炎症介质等的作用。消化内镜作为CP疼痛的重要微创治疗方法，主要包括内镜下胰管减压技术和神经干预技术。内镜下胰管减压技术以内镜逆行胰胆管造影术（ERCP）为基础，结合体外冲击波碎石术（ESWL），通过胰管取石和主胰管支架置入，有效降低胰管压力，缓解疼痛；内镜下神经干预技术主要包括超声内镜（EUS）引导下的腹腔神经丛阻滞/神经损毁术和射频消融术，通过抑制痛觉传导或破坏神经纤维，减轻疼痛。本文就CP腹痛的机制及消化内镜治疗进展进行综述。
郁思彦 , 谢弘俊 综述 , 吴高珏 审校 . 慢性胰腺炎疼痛的机制及内镜治疗进展[J]. 外科理论与实践, 2025 , 30(05) : 444 -449 . DOI: 10.16139/j.1007-9610.2025.05.11
Epigastric pain, the most common symptom of chronic pancreatitis (CP), seriously affects the quality of life and causes huge social and economic burden. The pathogenesis of pain involves pancreatic duct hypertension, neurogenic mechanisms, and the effects of inflammatory mediators. As a minimally invasive treatment, endoscopic therapy has emerged as a pivotal option for pain treatment in CP, primarily encompassing pancreatic duct decompression techniques and nerve interventions under endoscopy. Endoscopic pancreatic duct decompression, based on endoscopic retrograde cholangiopancreatography (ERCP) and combined with extracorporeal shock wave lithotripsy (ESWL), can effectively reduce pancreatic duct pressure and relieve pain through pancreatic duct stone removal and main pancreatic duct stent implantation. Endoscopic nerve intervention techniques mainly include celiac plexus block/neurolysis and radiofrequency ablation under the guidance of endoscopic ultrasonography (EUS), which can relieve pain by inhibiting nociceptive transmission or destroying nerve fibers. This article reviewed the mechanism of CP abdominal pain and the progress of endoscopic treatment.
Key words： Chronic pancreatitis （CP）; Abdominal pain; Endoscopy
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