Heyries Laurent, Sahel Jose
World J Gastroenterol. 2007 Dec 14;13(46):6127-33. doi: 10.3748/wjg.v13.i46.6127.
Treatment of chronic pancreatitis has been exclusively surgical for a long time. Recently, endoscopic therapy has become widely used as a primary therapeutic option. Initially performed for drainage of pancreatic cysts and pseudocysts, endoscopic treatments were adapted to biliary and pancreatic ducts stenosis. Pancreatic sphincterotomy which allows access to pancreatic ducts was firstly reported. Secondly, endoscopic methods of stenting, dilatation, and stones extraction of the bile ducts were applied to pancreatic ducts. Nevertheless, new improvements were necessary: failures of pancreatic stone extraction justified the development of extra-corporeal shock wave lithotripsy; dilatation of pancreatic stenosis was improved by forage with a new device; moreover endosonography allowed guidance for celiac block, gastro-cystostomy, duodeno-cystostomy and pancreatico-gastrostomy. Although endoscopic treatments are more and more frequently accepted, indications are still debated.
长期以来，慢性胰腺炎的治疗一直完全依靠外科手术。最近，内镜治疗已广泛用作主要治疗选择。内镜治疗最初用于胰腺囊肿和假性囊肿引流，后来也适用于胆管和胰管狭窄。首先报道了可进入胰管的胰括约肌切开术。其次，胆管支架置入、扩张和结石取出的内镜方法被应用于胰管。然而，仍需要新的改进：胰管结石取出失败促使体外冲击波碎石术的发展；一种新装置的探查改进了胰管狭窄的扩张；此外，内镜超声可为腹腔神经丛阻滞、胃囊肿造口术、十二指肠囊肿造口术和胰胃造口术提供引导。尽管内镜治疗越来越被广泛接受，但治疗指征仍存在争议。
