Kondo Hiromu, Naitoh Itaru, Ohara Hirotaka, Nakazawa Takahiro, Hayashi Kazuki, Okumura Fumihiro, Miyabe Katsuyuki, Shimizu Shuya, Nishi Yuji, Yoshida Michihiro, Yamashita Hiroaki, Umemura Shuichiro, Hori Yasuki, Kato Akihisa, Joh Takashi
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Dig Liver Dis. 2014 Jul;46(7):639-44. doi: 10.1016/j.dld.2014.02.017. Epub 2014 Apr 3.
Extracorporeal shock wave lithotripsy is the first-line therapy for large pancreatic duct stones; however, it requires a long duration of therapy.
To clarify the effect of pancreatic stenting prior to extracorporeal shock wave lithotripsy on shortening the duration of therapy and reducing complications.
We retrospectively compared 45 patients who underwent pancreatic stenting prior to extracorporeal shock wave lithotripsy (stenting group) and 35 patients who did not undergo stenting prior to extracorporeal shock wave lithotripsy (non-stenting group) with regard to the cumulative number of shock waves required for stone fragmentation (stone size <3mm) and the rate of complications.
The stenting group was associated with a significantly lower cumulative number of shock waves in univariate analysis (log-rank, p=0.046) and multivariate Cox proportional hazard analysis (hazard ratio, 1.88; 95% confidence interval, 1.13-3.14; p=0.015) than the non-stenting group. The frequency of pancreatitis tends to be lower in the stenting group than the non-stenting group (2.2% [1/45] vs 11.4% [4/35]; p=0.162).
Pancreatic stenting prior to extracorporeal shock wave lithotripsy reduced the cumulative number of shock waves required for pancreatic stone fragmentation, and could be useful to shorten the duration of therapy.
体外冲击波碎石术是治疗大胰管结石的一线疗法；然而，该疗法需要较长的治疗时间。
阐明体外冲击波碎石术前进行胰管支架置入对缩短治疗时间和减少并发症的效果。
我们回顾性比较了45例在体外冲击波碎石术前进行胰管支架置入的患者（支架置入组）和35例在体外冲击波碎石术前未进行支架置入的患者（非支架置入组），比较结石破碎（结石大小<3mm）所需的冲击波累积次数和并发症发生率。
在单因素分析（对数秩检验，p=0.046）和多因素Cox比例风险分析（风险比，1.88；95%置信区间，1.13 - 3.14；p=0.015）中，支架置入组的冲击波累积次数显著低于非支架置入组。支架置入组胰腺炎的发生率往往低于非支架置入组（2.2% [1/45] 对11.4% [4/35]；p=0.162）。
体外冲击波碎石术前进行胰管支架置入可减少胰管结石破碎所需的冲击波累积次数，有助于缩短治疗时间。
