{"id":219,"date":"2019-01-28T15:10:11","date_gmt":"2019-01-28T13:10:11","guid":{"rendered":"https:\/\/www.barnaclinic.com\/blog\/cirugia-del-pancreas\/ca\/?p=219"},"modified":"2019-01-28T15:10:11","modified_gmt":"2019-01-28T13:10:11","slug":"evolucio-de-la-pancreatitis-cronica","status":"publish","type":"post","link":"https:\/\/www.barnaclinic.com\/blog\/cirugia-del-pancreas\/ca\/evolucio-de-la-pancreatitis-cronica\/","title":{"rendered":"Evoluci\u00f3 de la pancreatitis cr\u00f2nica. Quan i com s’ha d’operar?"},"content":{"rendered":"

La\u00a0pancreatitis cr\u00f2nica<\/strong><\/a>\u00a0\u00e9s una patologia que produeix una s\u00e8rie de canvis al p\u00e0ncrees<\/strong>\u00a0com a conseq\u00fc\u00e8ncia d’una inflamaci\u00f3 mantinguda en el temps.<\/span>\u00a0En els casos evolucionats, s’acompanya d’una\u00a0p\u00e8rdua de la funci\u00f3 pancre\u00e0tica<\/a><\/strong>,\u00a0tant endocrina com exocrina, i de l’aparici\u00f3 de\u00a0canvis morfol\u00f2gics al p\u00e0ncrees.<\/strong><\/span>\u00a0Aquests canvis apareixen com a conseq\u00fc\u00e8ncia de la p\u00e8rdua del teixit pancre\u00e0tic normal, la seva\u00a0substituci\u00f3 per un teixit fibr\u00f3s<\/a>, i per l’aparici\u00f3 de m\u00faltiples calcificacions que, de vegades, poden obstruir parcialment o totalment el conducte pancre\u00e0tic principal.<\/span><\/p>\n

<\/p>\n

EVOLUCI\u00d3 DE LA PANCREATITIS CR\u00d2NICA<\/span><\/h2>\n

Els pacients que tenen una\u00a0pancreatitis cr\u00f2nica<\/strong><\/a>\u00a0evolucionada poden presenten un quadre de\u00a0diabetis<\/strong>\u00a0i de\u00a0desnutrici\u00f3<\/strong>\u00a0manifesta.<\/span>\u00a0Les dues complicacions s\u00f3n conseq\u00fc\u00e8ncia de la\u00a0p\u00e8rdua de la funci\u00f3 digestiva del p\u00e0ncrees<\/strong>.<\/span>\u00a0El s\u00edmptoma m\u00e9s habitual en aquests pacients \u00e9s el dolor.<\/span>\u00a0L’origen d’aquest dolor no \u00e9s ben compr\u00e8s encara, per\u00f2 es creu que apareix com a conseq\u00fc\u00e8ncia de la\u00a0inflamaci\u00f3 peripancre\u00e1tica<\/strong>\u00a0i de la dilataci\u00f3 dels conductes pancre\u00e0tics.<\/span><\/p>\n

TRACTAMENT M\u00c8DIC DE LA PANCREATITIS CR\u00d2NICA<\/span><\/h2>\n

Si no es realitza cap acci\u00f3, i es mant\u00e9 la causa que produeix aquesta\u00a0pancreatitis cr\u00f2nica,<\/strong>\u00a0el pacient empitjorar\u00e0 cl\u00ednicament i acabar\u00e0 amb una molt mala qualitat de vida i fins i tot amb l’aparici\u00f3 de complicacions locals que poden posar al pacient en perill vital.<\/span>\u00a0No obstant aix\u00f2, pot realitzar-se un tractament m\u00e8dic mitjan\u00e7ant la substituci\u00f3 de la\u00a0funci\u00f3 pancre\u00e0tica<\/strong>\u00a0que el pacient ha perdut.<\/span>\u00a0Fins i tot, pot plantejar-se el drenatge del conducte pancre\u00e0tic en alguns pacients mitjan\u00e7ant t\u00e8cniques endosc\u00f2piques.<\/span><\/p>\n

TRACTAMENT QUIR\u00daRGIC DE LA PANCREATITIS CR\u00d2NICA EVOLUCIONADA I “REBEL”<\/span><\/h2>\n

Davant d’una\u00a0pancreatitis cr\u00f2nica evolucionada,<\/strong>\u00a0que sigui rebel al tractament m\u00e8dic i endosc\u00f2pic, cal fer una profunda avaluaci\u00f3 de la\u00a0morfologia del p\u00e0ncrees,<\/strong>\u00a0per detectar la localitzaci\u00f3 del problema fonamental, aix\u00ed com la seva extensi\u00f3 i la pres\u00e8ncia o no de dilataci\u00f3 del conducte pancre\u00e0tic.<\/span>\u00a0Aix\u00ed doncs, en aquest tipus de pacients pot plantejar-se un tractament quir\u00fargic que tingui com a missi\u00f3: o b\u00e9 descomprimir el p\u00e0ncrees, o b\u00e9\u00a0extirpar la part del p\u00e0ncrees<\/strong><\/a>\u00a0que no \u00e9s funcional.<\/span>\u00a0Aquesta part no funcional podria plantejar dubtes diagn\u00f2stics amb la pres\u00e8ncia d’un\u00a0tumor pancre\u00e0tic<\/strong>.<\/span>\u00a0Cal recordar que els pacients amb\u00a0pancreatitis cr\u00f2nica<\/strong>\u00a0tenen un risc incrementat respecte a la poblaci\u00f3 general de patir\u00a0un\u00a0c\u00e0ncer de p\u00e0ncrees<\/strong><\/a>\u00a0i, a m\u00e9s, des del punt de vista radiol\u00f2gic, s\u00f3n pacients dif\u00edcils d’avaluar.<\/span><\/p>\n

\n

\"dr-santiago-sanchez-cabus\"<\/h4>\n

“Davant d’una\u00a0pancreatitis cr\u00f2nica evolucionada,<\/strong>\u00a0rebel al tractament m\u00e8dic i endosc\u00f2pic, pot plantejar-se un tractament quir\u00fargic per descomprimir el p\u00e0ncrees o per\u00a0extirpar la part no funcional del mateix”<\/strong><\/span><\/h4>\n

Dr.\u00a0Santiago S\u00e1nchez Cab\u00fas<\/a><\/p><\/blockquote>\n

DRENATGE DEL CONDUCTE PANCRE\u00c0TIC PRINCIPAL PER A UNA ALTA RESOLUCI\u00d3 DEL DOLOR<\/h2>\n

En definitiva, el cirurgi\u00e0 haur\u00e0 de decidir de forma individualitzada si el pacient presenta o no una\u00a0pancreatitis cr\u00f2nica<\/a>\u00a0tribut\u00e0ria de tractament quir\u00fargic<\/strong>\u00a0i quin tipus de cirurgia realitzar.<\/span>\u00a0En els pacients intervinguts quir\u00fargicament, la resoluci\u00f3 de la cl\u00ednica de dolor \u00e9s elevada, arribant en algunes s\u00e8ries fins a unes taxes de resoluci\u00f3 de dolor del 80- 90%.<\/span>\u00a0En la mesura del\u00a0possible, el tractament quir\u00fargic d’elecci\u00f3 per a la pancreatitis cr\u00f2nica ha de ser el drenatge del conducte pancre\u00e0tic principal.<\/strong><\/span>\u00a0Escollim aquest procediment per davant de\u00a0la\u00a0pancreatectomia<\/strong><\/a>\u00a0perqu\u00e8 aquesta \u00faltima \u00e9s molt agressiva, especialment en aquests pacients amb condicions locals no sempre favorables.<\/span><\/p>\n

\n

\"dr-santiago-sanchez-cabus\"<\/h4>\n

“En la mesura del\u00a0possible, el tractament quir\u00fargic d’elecci\u00f3 per a la pancreatitis cr\u00f2nica ha de ser el drenatge del conducte pancre\u00e0tic principal”<\/strong><\/span><\/h4>\n

Dr.\u00a0Santiago S\u00e1nchez Cab\u00fas<\/a><\/p><\/blockquote>\n

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\n
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<\/p>\n

VOL CONTACTAR AMB EL DR. SANTIAGO S\u00c1NCHEZ CAB\u00daS?<\/span><\/h1>\n

DEMANAR CITA<\/a><\/p>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

La\u00a0pancreatitis cr\u00f2nica\u00a0\u00e9s una patologia que produeix una s\u00e8rie de canvis al p\u00e0ncrees\u00a0com a conseq\u00fc\u00e8ncia d’una inflamaci\u00f3 mantinguda en el temps.\u00a0En els casos evolucionats, s’acompanya d’una\u00a0p\u00e8rdua de la funci\u00f3 pancre\u00e0tica,\u00a0tant endocrina com exocrina, i de l’aparici\u00f3 de\u00a0canvis morfol\u00f2gics al p\u00e0ncrees.\u00a0Aquests canvis apareixen com a conseq\u00fc\u00e8ncia de la p\u00e8rdua del teixit pancre\u00e0tic normal, la seva\u00a0substituci\u00f3 per un […]<\/p>\n","protected":false},"author":2,"featured_media":218,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[43],"tags":[49,55],"yoast_head":"\nEvoluci\u00f3 de la pancreatitis cr\u00f2nica. 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