慢性胰腺炎疼痛的机制及内镜治疗进展

doi:10.16139/j.1007-9610.2025.05.11

摘要/Abstract

摘要：

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。

关键词: 慢性胰腺炎, 腹痛, 内镜

Abstract:

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

中图分类号:

R576
R441.1

郁思彦, 谢弘俊, 吴高珏. 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.

YU Siyan, XIE Hongjun, WU Gaojue. Progress in mechanism and endoscopic therapy on pain in chronic pancreatitis[J]. Journal of Surgery Concepts & Practice, 2025, 30(05): 444-449.

参考文献 44

[1]	XIAO A Y, TAN M L, WU L M, et al. Global incidence and mortality of pancreatic diseases: a systematic review, meta-analysis, and meta-regression of population-based cohort studies[J]. Lancet Gastroenterol Hepatol, 2016, 1(1):45-55. doi: 10.1016/S2468-1253(16)30004-8 URL
[2]	THIERENS N, VERDONK R C, LÖHR J M, et al. Chronic pancreatitis[J]. Lancet, 2025, 404(10471):2605-2618. doi: 10.1016/S0140-6736(24)02187-1 pmid: 39647500
[3]	CAI Q Y, TAN K, ZHANG X L, et al. Incidence, prevalence, and comorbidities of chronic pancreatitis: a 7-year population-based study[J]. World J Gastroenterol, 2023, 29(30):4671-4684. doi: 10.3748/wjg.v29.i30.4671 URL
[4]	BEYER G, HABTEZION A, WERNER J, et al. Chronic pancreatitis[J]. Lancet, 2020, 396(10249):499-512. doi: S0140-6736(20)31318-0 pmid: 32798493
[5]	DREWES A M, BOUWENSE S A W, CAMPBELL C M, et al. Guidelines for the understanding and management of pain in chronic pancreatitis[J]. Pancreatology, 2017, 17(5):720-731. doi: S1424-3903(17)30515-X pmid: 28734722
[6]	OLESEN S S, NØJGAARD C, POULSEN J L, et al. Chronic pancreatitis is characterized by distinct complication clusters that associate with etiological risk factors[J]. Am J Gastroenterol, 2019, 114(4):656-664. doi: 10.14309/ajg.0000000000000147 pmid: 30741740
[7]	SALOMAN J L, JENNINGS K, STELLO K, et al. Pancrea-titis pain quality changes at year 1 follow-up, but GP130 remains a biomarker for pain[J]. Pancreatology, 2024, 24(7):993-1002. doi: 10.1016/j.pan.2024.09.016 URL
[8]	SALOMAN J L, TANG G, STELLO K M, et al. Serum biomarkers for chronic pancreatitis pain patterns[J]. Pancreatology, 2021, 21(8):1411-1418. doi: 10.1016/j.pan.2021.09.016 pmid: 34602367
[9]	WANG Y, LI H T, LIU G, et al. COMP promotes pancrea-tic fibrosis by activating pancreatic stellate cells through CD36-ERK/AKT signaling pathways[J]. Cell Signal, 2024,118:111135.
[10]	DEMIR I E, HEINRICH T, CARTY D G, et al. Targeting nNOS ameliorates the severe neuropathic pain due to chronic pancreatitis[J]. EBioMedicine, 2019,46:431-443.
[11]	MUTHULINGAM J, OLESEN S S, HANSEN T M, et al. Progression of structural brain changes in patients with chronic pancreatitis and its association to chronic pain: a 7-year longitudinal follow-up study[J]. Pancreas, 2018, 47(10):1267-1276. doi: 10.1097/MPA.0000000000001151 URL
[12]	LEE J A, CHEN Q, ZHUO M. Synaptic plasticity in the pain-related cingulate and insular cortex[J]. Biomedicines, 2022, 10(11):2745. doi: 10.3390/biomedicines10112745 URL
[13]	WALKER J, BABYOK O L, SALOMAN J L, et al. Recent advances in the understanding and management of chronic pancreatitis pain[J]. J Pancreatol, 2024, 7(1):35-44. doi: 10.1097/JP9.0000000000000163 URL
[14]	DUMONCEAU J M, DELHAYE M, TRINGALI A, et al. Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) guideline - updated August 2018[J]. Endoscopy, 2019, 51(2):179-193. doi: 10.1055/a-0822-0832 URL
[15]	TALUKDAR R, OLESEN S S, UNNISA M, et al. Extracorporeal shock-wave lithotripsy and endoscopy for the treatment of pain in chronic pancreatitis : a sham-controlled, randomized trial[J]. Ann Intern Med, 2024, 177(6):749-758. doi: 10.7326/M24-0210 pmid: 38801774
[16]	中国医师协会胰腺病学专业委员会, 国家消化系统疾病临床医学研究中心(上海). 胰腺体外震波碎石术专家共识[J]. 中华胰腺病杂志, 2024, 24(2):94-99.
	Professional Committee of Pancreatic Diseases, Chinese Medical Doctor Association, National Clinical Research Center for Digestive Diseases (Shanghai). Expert consensus on pancreatic extracorporeal shock wave lithotripsy[J]. Chin J Pancreatology, 2024, 24(2):94-99.
[17]	ASGE Standards of Practice Committee, SHETH S G, MACHICADO J D, et al. American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the management of chronic pancreatitis: summary and recommendations[J]. Gastrointest Endosc, 2024, 100(4):584-594. doi: 10.1016/j.gie.2024.05.016 pmid: 39115496
[18]	BREWER GUTIERREZ O I, RAIJMAN I, SHAH R J, et al. Safety and efficacy of digital single-operator pancreatoscopy for obstructing pancreatic ductal stones[J]. Endosc Int Open, 2019, 7(7):E896-E903.
[19]	SAGHIR S M, MASHIANA H S, MOHAN B P, et al. Efficacy of pancreatoscopy for pancreatic duct stones: a systematic review and meta-analysis[J]. World J Gastroenterol, 2020, 26(34):5207-5219. doi: 10.3748/wjg.v26.i34.5207 URL
[20]	GUZMÁN-CALDERÓN E, MARTINEZ-MORENO B, CASELLAS J A, et al. Per-oral pancreatoscopy-guided lithotripsy for the endoscopic management of pancreatolithiasis: a systematic review and meta-analysis[J]. J Dig Dis, 2021, 22(10):572-581. doi: 10.1111/cdd.v22.10 URL
[21]	ITO K, TAKUMA K, OKANO N, et al. Current status and future perspectives for endoscopic treatment of local complications in chronic pancreatitis[J]. Dig Endosc, 2025, 37(3):219-235. doi: 10.1111/den.v37.3 URL
[22]	ITO K, OKANO N, TAKUMA K, et al. Are newer extracorporeal shock wave lithotripsy models truly improving pancreatolithiasis lithotripsy performance? A Japanese single-center study using endoscopic adjunctive treatment[J]. Gut Liver, 2023, 17(4):647-658. doi: 10.5009/gnl220204 URL
[23]	CAI Y L, WANG F, ZHANG J, et al. Incidence, risk factors and endoscopic retrieval of proximally migrated pancreatic stents: 25 years of experience in a high-volume center - a case controlled study[J]. Int J Surg, 2025, 111(4):3115-3119. doi: 10.1097/JS9.0000000000002273 URL
[24]	SONNENBERG A, BAUERFEIND P, BAKIS G. Cost-utility advantage of interventional endoscopy[J]. Surg Endosc, 2023, 37(2):1031-1037. doi: 10.1007/s00464-022-09599-8
[25]	UDD M, KYLÄNPÄÄ L, KOKKOLA A. The role of endoscopic and surgical treatment in chronic pancreatitis[J]. Scand J Surg, 2020, 109(1):69-78. doi: 10.1177/1457496920910009 pmid: 32192421
[26]	JAFRI M, SACHDEV A, SADIQ J, et al. Efficacy of endotherapy in the treatment of pain associated with chronic pancreatitis: a systematic review and meta-analysis[J]. JOP, 2017, 18(2):125-132.
[27]	CAHEN D L, GOUMA D J, NIO Y, et al. Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis[J]. N Engl J Med, 2007, 356(7):676-684. doi: 10.1056/NEJMoa060610 URL
[28]	中华医学会消化内镜学分会ERCP学组, 中国医师协会消化医师分会胆胰学组, 国家消化系统疾病临床医学研究中心. 中国ERCP指南(2018版)[J]. 中华消化内镜杂志, 2018, 35(11):777-813.
	ERCP Group, Chinese Society of Digestive Endoscopology, Biliopancreatic Group, Chinese Association of Gastroenterologist and Hepatologist, National Clinical Research Center for Digestive Diseases. Guidelines for ERCP(2018, China)[J]. Chin J Dig Endosc, 2018, 35(11):777-813.
[29]	FAN H, LI N, ZHANG X, et al. A review on pancreatic duct stents: materials and emerging trends[J]. Biomed Mater, 2025, 20(3).
[30]	LI M, WANG X, LIN X, et al. Comparison and analysis of gut microbiota in children with IgA vasculitis with different clinical symptoms[J]. Front Pediatr, 2022,9:800677.
[31]	VAN DER MERWE S W, VAN WANROOIJ R L J, BRONSWIJK M, et al. Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) guideline[J]. Endoscopy, 2022, 54(2):185-205. doi: 10.1055/a-1717-1391 URL
[32]	TYBERG A, SHARAIHA R Z, KEDIA P, et al. EUS-guided pancreatic drainage for pancreatic strictures after failed ERCP: a multicenter international collaborative study[J]. Gastrointest Endosc, 2017, 85(1):164-169. doi: S0016-5107(16)30381-9 pmid: 27460387
[33]	VILA J J, FERNÁNDEZ-URIÉN I, CARRASCOSA J. EUS and ERCP: a rationale categorization of a productive partnership[J]. Endosc Ultrasound, 2021, 10(1):25-32. doi: 10.4103/eus.eus_58_20 pmid: 33353903
[34]	国家消化病临床医学研究中心(上海), 中华医学会消化内镜学分会超声内镜学组, 中国医师协会胰腺病学专业委员会. 中国胰腺假性囊肿内镜诊治专家共识意见(2022年)[J]. 中华胰腺病杂志, 2022, 22(5):321-334.
	National Clinical Research Center for Digestive Diseases(Shanghai), Ultrasound Endoscopy Group, Chinese Socie-ty of Digestive Endoscopology, Professional Committee of Pancreatic Disease, Chinese Medical Doctor Association. Chinese expert consensus on endoscopic diagnosis and treatment for pancreatic pseudocyst(2022)[J]. Chin J Panc reatology, 2022, 22(5):321-334.
[35]	WYSE J M, BATTAT R, SUN S, et al. Practice guidelines for endoscopic ultrasound-guided celiac plexus neurolysis[J]. Endosc Ultrasound, 2017, 6(6):369-375. doi: 10.4103/eus.eus_97_17 pmid: 29251270
[36]	CHAN L K M, RAO T, MASANGCAY P, et al. A systematic review and meta-analysis of the efficacy of endoscopic ultrasound guided celiac plexus blocks for chronic pancreatitis pain[J]. J Pain Palliat Care Pharmacother, 2025, 39(2):254-265. doi: 10.1080/15360288.2025.2479481 pmid: 40168184
[37]	KAMATA K, KINOSHITA M, KINOSHITA I, et al. Efficacy of EUS-guided celiac plexus neurolysis in combination with EUS-guided celiac ganglia neurolysis for pancreatic cancer-associated pain: a multicenter prospective trial[J]. Int J Clin Oncol, 2022, 27(7):1196-1201. doi: 10.1007/s10147-022-02160-6 pmid: 35412211
[38]	LEBLANC J K, DEWITT J, JOHNSON C, et al. A prospective randomized trial of 1 versus 2 injections during EUS-guided celiac plexus block for chronic pancreatitis pain[J]. Gastrointest Endosc, 2009, 69(4):835-842. doi: 10.1016/j.gie.2008.05.071 URL
[39]	MOUTINHO-RIBEIRO P, COSTA-MOREIRA P, CALDEIRA A, et al. Endoscopic ultrasound-guided celiac plexus interventions[J]. GE Port J Gastroenterol, 2020, 28(1):32-38. doi: 10.1159/000508293 URL
[40]	SCHNEIDER A, HIRTH M. Pain management in chronic pancreatitis: summary of clinical practice, current challenges and potential contribution of the M-ANNHEIM classification[J]. Drugs, 2021, 81(5):533-546. doi: 10.1007/s40265-021-01472-7 pmid: 33587287
[41]	CORNMAN-HOMONOFF J, HOLZWANGER D J, LEE K S, et al. Celiac plexus block and neurolysis in the management of chronic upper abdominal pain[J]. Semin Intervent Radiol, 2017, 34(4):376-386. doi: 10.1055/s-0037-1608861 URL
[42]	STOUVENOT M, KOCH S, FRONTZCAK A, et al. Effectiveness and safety of endoscopic ultrasound-guided radiofrequency ablation for pancreatic metastases of renal cell carcinoma[J]. Endosc Int Open, 2025,13:a25667350.
[43]	MATSUMOTO K, UCHIDA D, TAKEUCHI Y, et al. Efficacy and safety of endoscopic ultrasonography-guided radiofrequency ablation of small pancreatic neuroendocrine neoplasms: a prospective, pilot study[J]. DEN Open, 2025, 5(1):e70073. doi: 10.1002/deo2.v5.1 URL
[44]	BANG J Y, SUTTON B, HAWES R H, et al. EUS-guided celiac ganglion radiofrequency ablation versus celiac plexus neurolysis for palliation of pain in pancreatic cancer: a randomized controlled trial (with videos)[J]. Gastrointest Endosc, 2019, 89(1):58-66.e3. doi: 10.1016/j.gie.2018.08.005 URL