慢性胰腺炎（CP ）是一种持续进展的非自限性疾病，主要以炎性反应、纤维化、胰腺腺泡及胰岛细胞的缺失为特征。持久反复的疼痛是CP患者最突出的临床表现，减轻疼痛、提高生活质量仍是临床医生所面临的巨大挑战。目前临床上尚无根治性治疗手段，治疗目标往往围绕缓解疼痛来进行，主要治疗手段包括内科药物治疗、内镜治疗及手术治疗。此文就CP疼痛的治疗进展作一综述。

Objective To study the clinical value and the safety of endoscopic retrograde cholangio-pancreatography(ERCP)for chronic pancreatitis in the pediatric population.Methods Clinical data,endo-scopic reports,and radiography of chronic pancreatic patients aged from 2 to 17 years old who underwent ERCP between Jan.1,2008 and Apr.30,2014 at Endoscopy Center of Ruijin Hospital were reviewed.These patients were divided into 3 groups,patients aged from 2 to 6 years old as children group(n =27),patients aged from 7 to 12 years old as juvenile group(n =35)and patients aged from 13 to 17 as adolescent group(n =25). Their clinical data and complications were analyzed by groups.Results A total of 170 ERCP procedures were performed in 87 patients,with the success rate of 99.4%(169 /170).All patients were diagnosed as having chronic pancreatitis by ERCP.Success rates of children group,juvenile group and adolescent group were 97.6%(40 /41),100.0%(72 /72)and 100.0%(57 /57)respectively.There was no statistically significance among the three groups(P =0.207).No serious complications like bleeding or perforation occurred.No proce-dure-related mortality occurred in this study either.The rate of post-ERCP adverse events in children group, juvenile group and adolescent group were 41.5%(17 /41),25.0%(18 /72)and 24.6%(14/57),respective-ly.Children group had more adverse events than the juvenile group(P =0.039)and adolescent group(P =0.045).Conclusion Pediatric ERCP is highly effective in the pediatric population with chronic pancreatitis. The incidence of post ERCP adverse events is higher among the youngest children.

Objective To evaluate the efficacy and safety of endoscopic retrograde cholangiopancre-atography (ERCP)by using a duodenoscope in patients with prior Billroth Ⅱ gastrectomy.Methods Data of 98 patients(including 7 who underwent Billroth Ⅱand Braun)with prior Billroth Ⅱ gastrectomy who un-derwent ERCP from January 2008 to May 2014 at Endoscopy Center of Ruijin Hospital were retrospectively studied.Results A total of 98 patients accepted 111 ERCP procedures,the overall success rate was 75.7%(84 /111).The success rate of accessing Vater′s papilla was 82.0%(91 /111)and the selective can-nulations success rate was 92.3%(84 /91).In the cases of successful access,therapeutic procedures were achieved in 100.0%(84 /84)of all patients.The overall rate of complications was 4.5%(5 /111),with mild post-procedure pancreatitis occurring in 3 cases,cholangitis in 2 cases,respectively.Conclusion ERCP u-sing a duodenoscope can be safely and effectively performed in patients with prior Billroth Ⅱ gastrectomy with high cannulation and treatment success rates.

Objective To evaluate the indications,efficacy and safety of ERCP for nonagenarians and centenarians patients.Methods Data of nonagenarian or centenarian patients who went through ERCP in our hospital between January 1 st,2001 and March 31st,2014 were retrospectively analyzed.Their clinical characteristics,procedures of ERCP and complications after ERCP were also analyzed.Results A total of 97 nonagenarian or centenarian patients underwent 113 ERCP procedures,the success rate of cannulation was 96.5％,and the final success rate was 92.0％.Of the 97 patients,74 were diagnosed as having extrahepatic bile duct stones and/or bile duct infection,18 malignant obstructive jaundice,and 5 other benign pancreaticobiliary diseases.The overall ERCP related complication rate was 11.5％,mortality being 3.1％.Other complications were mild or moderate,and patients could recover in several days.Conclusion ERCP is both effective and safe for nonagenarian or centenarian patients,however,more research with larger samples is still needed to support it.