den Toom R, Nijs H G, van Blankenstein M, Schröder F H, Jeekel J, Terpstra O T
Department of Surgery, University Hospital Dijkzigt, Erasmus University, Rotterdam, The Netherlands.
Am J Gastroenterol. 1991 Aug;86(8):1033-6.
Chronic calcifying pancreatitis presents a major clinical problem, often requiring extensive surgery. Extracorporeal shock wave lithotripsy (ESWL) offers a new therapeutic option. We applied ESWL after endoscopic sphincterotomy of the pancreatic orifice in eight patients with impacted pancreatic duct stones. An electromagnetic lithotriptor (Siemens Lithostar, Erlangen, FRG) was used. Patients were treated in prone position under fluoroscopic control. A mean of 6,813 shock waves (range 1,500-10,000) was delivered in one or two sessions. Disintegration of stones was achieved in 6/8 patients, initial relief of pain in 7/8 patients, and total clearance of the pancreatic duct in 3/8 patients. One patient had an exacerbation of her pancreatitis one day after ESWL, which resolved rapidly with medical treatment. No other complications were observed. Four of five patients with fragmented stones had no abdominal complaints at follow-up (mean 17 months, range 3-27). Three patients in whom ESWL was not completely successful (two without and one with partial fragmentation) underwent an operation according to Puestow. Two of them still have abdominal complaints after surgery. From these data, we conclude that ESWL of pancreatic duct stones is a promising new alternative for surgery, when endoscopic stone extraction fails.
慢性钙化性胰腺炎是一个主要的临床问题，常常需要进行广泛的手术。体外冲击波碎石术（ESWL）提供了一种新的治疗选择。我们对8例胰管结石嵌顿患者在胰管口内镜括约肌切开术后应用了ESWL。使用了一台电磁碎石机（西门子Lithostar，德国埃尔兰根）。患者在透视控制下取俯卧位接受治疗。一或两个疗程平均施加6813次冲击波（范围1500 - 10000次）。8例患者中有6例结石碎裂，8例患者中有7例疼痛初步缓解，8例患者中有3例胰管完全通畅。1例患者在ESWL术后1天胰腺炎加重，经药物治疗后迅速缓解。未观察到其他并发症。5例结石碎裂的患者中有4例在随访时（平均17个月，范围3 - 27个月）无腹部不适。3例ESWL不完全成功的患者（2例结石未碎裂，1例部分碎裂）接受了Puestow手术。其中2例术后仍有腹部不适。根据这些数据，我们得出结论，当内镜下取石失败时，胰管结石的ESWL是一种有前景的手术替代方法。
