Lawrence Christopher, Siddiqi M Faisal, Hamilton Jonathan N, Keane Thomas E, Romagnuolo Joseph, Hawes Robert H, Cotton Peter B
Division of Gastroenterology, Medical University of South Carolina, College of Medicine, Charleston, SC 29425-2900, USA.
South Med J. 2010 Jun;103(6):505-8. doi: 10.1097/SMJ.0b013e3181d993ef.
Chronic pancreatitis is commonly associated with debilitating abdominal pain, in part due to pancreatic duct obstruction. Pancreatic stones are often impossible to extract from the duct with endoscopic retrograde cholangiopancreatography alone. Extracorporeal shock wave lithotripsy (ESWL) is commonly used for fragmentation of obstructing nephrolithiasis and has demonstrated effectiveness in management of pancreatic stones. Our aim was to examine the outcomes of the first 30 patients with symptomatic pancreatic stones treated with a combination of ESWL and endoscopic therapies.
Patients with symptomatic chronic calcific pancreatitis referred for ESWL (2005-2009) were included. Technical success of ESWL was defined as a) stone fragmentation sufficient to allow extraction of main duct stones at ERCP or b) absence of the targeted main pancreatic duct stones on follow-up radiography. Clinical success of ESWL was defined by Patient Global Impression of Improvement (PGII) score of at least slightly improved.
Thirty patients underwent ESWL. One patient was excluded due to adenocarcinoma. Technical success was achieved in 17/29 (58.6%) patients. 25 (86.2%) patients were available for follow-up (median 35 months, range 3-52 months). Fifteen of twenty-five (60%) patients experienced clinical improvement (10 patients very much improved), but there was no significant reduction in the proportion taking narcotics (50% before vs. 44.4% after ESWL). Pancreatic surgery has been avoided to date in 16 (64%) of the 25 patients.
A multidisciplinary approach, combining ERCP and ESWL, to painful obstructing pancreatic duct stones provided symptomatic improvement and allowed pancreatic surgery to be avoided in the majority of patients.
慢性胰腺炎常伴有使人衰弱的腹痛，部分原因是胰管梗阻。仅通过内镜逆行胰胆管造影术往往无法从胰管中取出胰石。体外冲击波碎石术（ESWL）常用于击碎阻塞性肾结石，并已证明在治疗胰石方面有效。我们的目的是研究前30例接受ESWL与内镜治疗联合治疗的有症状胰石患者的治疗结果。
纳入2005 - 2009年因ESWL前来就诊的有症状慢性钙化性胰腺炎患者。ESWL的技术成功定义为：a）结石破碎程度足以在ERCP时取出主胰管结石，或b）随访影像学检查未发现目标主胰管结石。ESWL的临床成功定义为患者整体改善印象（PGII）评分至少稍有改善。
30例患者接受了ESWL治疗。1例因腺癌被排除。17/29（58.6%）例患者取得技术成功。25例（86.2%）患者可进行随访（中位时间35个月，范围3 - 52个月）。25例患者中有15例（60%）病情得到临床改善（10例患者改善明显），但服用麻醉剂的比例没有显著降低（ESWL前为50%，ESWL后为44.4%）。25例患者中有16例（64%）至今避免了胰腺手术。
对于疼痛性阻塞性胰管结石，采用ERCP和ESWL联合的多学科方法可改善症状，并使大多数患者避免了胰腺手术。
