慢性膵炎の経過と予後に関する研究 第3編 合併症，予後および予後決定因子について

To investigate complications, prognosis and prognostic factors for chronic pancreatitis (CP), 170 patients with CP (112 with alcoholic CP, nine with biliary CP and 49 with idiopathic CP) were followed up. Pancreatic pseudocysts were found in 29 patient with CP, biliary stenosis in 20 patients, and a peptic ulcer in 26 patients. Determination of whether the abdominal pain is caused by acute exacerbation of CP or by the peptic ulcer is important, because abdominal pain due to peptic ulcer is easily relieved by administration of H2-receptor antagonist. Mild liver damage or chronic hepatitis was observed in 26 patients with CP ; and liver cirrhosis in nine. Duodenal stenosis was found in two patients. Thirty-nine patients with CP died during the follow-up period. Patients with alcoholic CP were significantly younger than those with nonalcoholic CP at the time of death. Thirteen patients died from malignancy which was the most frequent cause of deaths. Sudden deaths were observed in seven patients. Six patients died from pneumonia which was refractory to the intensive medical treatment. Three patients died from diabetic renal failure and three from heart failure. The observed number of CP was significantly higher than the expected number for the sex-age-matched general population in total deaths and cancer deaths. A similar finding was obtained in alcoholic CP. Alcoholic CP showed poorer prognosis than nonalcoholic CP. Contributing factors to the prognosis were age at the time of diagnosis, diabetes, smoking habit, outcome of pain, years at diagnosis in alcoholic CP, whereas they were age at diagnosis, smoking habit and diabetes in nonalcoholic CP. This indicates that abstinence, quitting smoking, and careful treatment for diabetes are important for improving the prognosis of CP.

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