慢性膵炎の経過と予後に関する研究 第2編 疼痛経過，生活の質の変化および治療法について

To investigate the relief of pain, quality of life and treatment of chronic pancreatitis (CP), 112 patients with alcoholic CP, nine with biliary CP and 49 with idiopahtic CP were followed up. Partial or complete relief of pain was obtained in 64 patients with alcoholic CP (66%), nine with biliary CP (100%) and 29 with idiopathic CP (88%). Alcoholic CP showed a significantly lower ratio of pain relief than nonalcoholic CP. A long follow-up period (≧6 years revealed greater pain relief. Patients with discontinued or decreased intake of alcohol showed a significantly higher ratio of pain relief than those continuing drinking. These findings indicate that factors contributing to pain relief are etiological category of CP, drinking habit after diagnosis and length of the follow-up period. Deterioration in quality of life was observed in 42 patients with alcoholic CP, one with biliary CP and 13 with idiopathic CP. Main causes for the deterioration in quality of life were pain, diabetes and loss of interest in work. Abstinence is important for patinets with CP to maintain their quality of life. Endoscopic removal of protein plug contributed to pain relief. Surgical treatment was done in 54 patients with CP. Pain relief was observed in 41 operated patients, and deterioration in the quality of life in 17. Abstinence was important for operated patients as well as non-operated patients to obtain pain relief and maintain the quality of life. Clinically overt steatorrhea was observed in two patients with CP, which was improved by a large dose of enzyme replacement therapy. Aggravation of diabetes had been obsreved, and number of patients dependent on insulin therapy increased during the follow-up period. Diabetes must be treated carefully because diabetes is an important factor contributing to the prognosis of CP.

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