Kim Yong Hoon, Jang Sung Ill, Rhee Kwangwon, Lee Dong Ki
Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
Clin Endosc. 2014 May;47(3):227-35. doi: 10.5946/ce.2014.47.3.227. Epub 2014 May 31.
Chronic pancreatitis is a progressive inflammatory disease that destroys pancreatic parenchyma and alters ductal stricture, leading to ductal destruction and abdominal pain. Pancreatic duct stones (PDSs) are a common complication of chronic pancreatitis that requires treatment to relieve abdominal pain and improve pancreas function. Endoscopic therapy, extracorporeal shock wave lithotripsy (ESWL), and surgery are treatment modalities of PDSs, although lingering controversies have hindered a consensus recommendation. Many comparative studies have reported that surgery is the superior treatment because of reduced duration and frequency of hospitalization, cost, pain relief, and reintervention, while endoscopic therapy is effective and less invasive but cannot be used in all patients. Surgery is the treatment of choice when endoscopic therapy has failed, malignancy is suspected, or duodenal stricture is present. However, in patients with the appropriate indications or at high-risk for surgery, endoscopic therapy in combination with ESWL can be considered a first-line treatment. We expect that the development of advanced endoscopic techniques and equipment will expand the role of endoscopic treatment in PDS removal.
慢性胰腺炎是一种进行性炎症性疾病，会破坏胰腺实质并改变导管狭窄，导致导管破坏和腹痛。胰管结石（PDSs）是慢性胰腺炎的常见并发症，需要进行治疗以缓解腹痛并改善胰腺功能。内镜治疗、体外冲击波碎石术（ESWL）和手术是PDSs的治疗方式，尽管长期存在的争议阻碍了达成共识性推荐。许多比较研究报告称，手术是更优的治疗方法，因为住院时间和频率、成本、疼痛缓解及再次干预均有所减少，而内镜治疗有效且侵入性较小，但并非适用于所有患者。当内镜治疗失败、怀疑有恶性肿瘤或存在十二指肠狭窄时，手术是首选治疗方法。然而，对于有适当适应证或手术风险高的患者，内镜治疗联合ESWL可被视为一线治疗方法。我们预计，先进内镜技术和设备的发展将扩大内镜治疗在清除PDSs中的作用。
