Kozarek Richard A, Brandabur John J, Ball Terrence J, Gluck Michael, Patterson David J, Attia Fouad, France Renee, Traverso L William, Koslowski Paul, Gibbons Robert P
Sections of Gastroenterology, Urology, and General Surgery, Virginia Mason Medical Center, Seattle, Washington 98101, USA.
Gastrointest Endosc. 2002 Oct;56(4):496-500. doi: 10.1067/mge.2002.128105.
There is controversy as to whether extracorporeal shock wave lithotripsy fragmentation and ERCP retrieval of pancreatic stones are associated with relief of chronic pain or relapsing attacks of pancreatitis. Our most recent experience with this technology is reviewed.
Forty patients with chronic calcific pancreatitis who required extracorporeal shock wave lithotripsy between 1995 and 2000 to facilitate pancreatic duct stone removal were retrospectively reviewed. Data collected included patient presentation, number of lithotripsy and ERCP sessions required, complications, and outcomes measures to include pre- and post-ESWL pain scale, monthly oxycodone (5 mg)-equivalent pills ingested, yearly hospitalizations, and need for subsequent surgery.
A single extracorporeal shock wave lithotripsy session was required for 35 patients who underwent a total of 86 ERCPs to achieve complete stone extraction from the main pancreatic duct. Minor complications occurred in 20%. There was one episode of pancreatic sepsis that was treated with antibiotics and removal of an occluded pancreatic prosthesis. At a mean [SD] follow-up of 2.4 (0.6) years, 80% of patients had avoided surgery and there was a statistically significant decrease in pain scores (6.9 [1.3] vs. 2.9 [1.1]; p = 0.001), yearly hospitalizations for pancreatitis (3.9 [1.9] vs. 0.9 [0.9]; p = 0.001), and oxycodone-equivalent narcotic medication ingested monthly (125 [83] vs. 81 [80]; p = 0.03).
Extracorporeal shock wave lithotripsy fragmentation of pancreatic duct calculi in conjunction with endoscopic clearance of the main pancreatic duct is associated with significant improvement in clinical outcomes in most patients with chronic pancreatitis.
关于体外冲击波碎石术破碎胰腺结石及经内镜逆行胰胆管造影术（ERCP）取出胰腺结石是否能缓解慢性疼痛或胰腺炎复发存在争议。本文回顾了我们使用该技术的最新经验。
回顾性分析了1995年至2000年间40例因慢性钙化性胰腺炎需要体外冲击波碎石术以促进胰管结石清除的患者。收集的数据包括患者表现、所需的碎石术和ERCP疗程数、并发症以及结局指标，包括体外冲击波碎石术前和术后的疼痛评分、每月摄入的羟考酮（5毫克）等效药丸数、每年住院次数以及后续手术需求。
35例患者仅需进行一次体外冲击波碎石术，共接受了86次ERCP以实现从主胰管完全取出结石。20%的患者出现了轻微并发症。发生了1例胰腺脓毒症，经抗生素治疗并移除了阻塞性胰腺假体。平均随访2.4（0.6）年时，80%的患者避免了手术，疼痛评分（6.9 [1.3]对2.9 [1.1]；p = 0.001）、胰腺炎每年住院次数（3.9 [1.9]对0.9 [0.9]；p = 0.001）以及每月摄入的羟考酮等效麻醉药物（125 [83]对81 [80]；p = 0.03）均有统计学意义的下降。
体外冲击波碎石术破碎胰管结石并结合内镜清除主胰管结石与大多数慢性胰腺炎患者的临床结局显著改善相关。
