Sherman S, Lehman G A, Hawes R H, Ponich T, Miller L S, Cohen L B, Kortan P, Haber G B
Department of Medicine, Indiana University Medical Center, Indianapolis.
Gastrointest Endosc. 1991 Sep-Oct;37(5):511-7. doi: 10.1016/s0016-5107(91)70818-3.
Pancreatic ductal stones may be responsible for attacks of acute pancreatitis (chronic relapsing pancreatitis) or exacerbations of chronic pain in patients with chronic pancreatitis. This study was undertaken to identify those patients with predominantly main pancreatic duct stones most amenable to endoscopic removal and to determine the effects on the patients' clinical course with such removal. Thirty-two patients with ductographic evidence of chronic pancreatitis and pancreatic duct stones underwent attempted endoscopic removal. Of the patients, 71.9% had complete or partial stone removal and 67.7% improved after endoscopic therapy. Symptomatic improvement was most evident in the group of patients with chronic relapsing pancreatitis. Factors favoring stone removal included (1) three or less stones, (2) stones confined to the head and/or body of the pancreas, (3) absence of a downstream stricture, (4) stone diameter less than or equal to 10 mm, and (5) absence of impacted stones. After successful stone removal, 25% of patients had regression of the ductographic changes of chronic pancreatitis and 41.7% had a decrease in the main pancreatic duct diameter. The only complication from therapy was mild pancreatitis in 8.2%. These data suggest that removal of pancreatic duct stones may result in symptomatic improvement. A longer follow-up will be necessary to determine whether endoscopic success results in long-standing clinical improvement and/or permanent regression of the morphologic changes of chronic pancreatitis.
胰管结石可能是急性胰腺炎（慢性复发性胰腺炎）发作或慢性胰腺炎患者慢性疼痛加重的原因。本研究旨在确定那些最适合内镜下取出主要胰管结石的患者，并确定这种取出对患者临床病程的影响。32例有慢性胰腺炎和胰管结石造影证据的患者尝试进行内镜下取石。其中，71.9%的患者结石完全或部分取出，67.7%的患者在内镜治疗后病情改善。症状改善在慢性复发性胰腺炎患者组中最为明显。有利于结石取出的因素包括：（1）结石数量为3个或更少；（2）结石局限于胰头和/或胰体；（3）不存在下游狭窄；（4）结石直径小于或等于10毫米；（5）不存在嵌顿结石。成功取石后，25%的患者慢性胰腺炎的造影改变有所消退，41.7%的患者主胰管直径减小。治疗的唯一并发症是8.2%的患者发生轻度胰腺炎。这些数据表明，取出胰管结石可能会改善症状。需要更长时间的随访来确定内镜治疗成功是否会导致长期临床改善和/或慢性胰腺炎形态学改变的永久性消退。
