体外冲击波碎石术是治疗合并胰腺假性囊肿的胰腺结石的一种安全有效的方法。
Extracorporeal shock wave lithotripsy is a safe and effective treatment for pancreatic stones coexisting with pancreatic pseudocysts.
作者信息
Li Bai-Rong, Liao Zhuan, Du Ting-Ting, Ye Bo, Chen Hui, Ji Jun-Tao, Zheng Zhao-Hong, Hao Jun-Feng, Ning Shou-Bin, Wang Dan, Lin Jin-Huan, Hu Liang-Hao, Li Zhao-Shen
机构信息
Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China; Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China; Department of Gastroenterology, Air Force General Hospital, Beijing, China.
Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China; Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China.
出版信息
Gastrointest Endosc. 2016 Jul;84(1):69-78. doi: 10.1016/j.gie.2015.10.026. Epub 2015 Nov 2.
BACKGROUND AND AIMS
We aimed to investigate outcomes of pancreatic extracorporeal shock wave lithotripsy (P-ESWL) for the removal of large pancreatic stones coexisting with pancreatic pseudocysts (PPCs) in chronic pancreatitis (CP).
METHODS
This is a prospective study performed in CP patients with at least 1 stone (≥5 mm). Patients were divided into the PPC group (stones coexisting with PPCs) or the control group (stones alone). Patients were initially subjected to successive P-ESWL treatments, followed by ERCP. Primary outcomes were P-ESWL adverse events, and secondary outcomes were stone clearance, long-term pain relief, improved quality-of-life scores, and PPC regression.
RESULTS
A total of 849 patients (59 in the PPC group and 790 in the control group) was subjected to P-ESWL between March 2011 and October 2013. Occurrences of P-ESWL adverse events were similar between the PPC group and the control group (11.86% vs 12.41%, P = .940). After the treatment of initial P-ESWL combined with ERCP, the complete, partial, and nonclearance of stones occurred in 67.24%, 20.69%, and 12.07%, respectively, of patients in PPC group, with no significant difference from the control group (complete, partial, and nonclearance: 83.17%, 10.40%, and 11.39%, respectively; P = .106). Fifty-five of 59 patients (93.22%) with PPCs were followed for a median period of 21.9 months (range, 12.0-45.1). PPCs disappeared in 56.36% (31/55) and 76.36% (42/55) of patients after 3 months and 1 year of follow-up visits, respectively. Moreover, complete and partial pain relief were achieved in 63.64% (35/55) and 25.45% (14/55) of patients, respectively. The scores for quality of life (P < .001), physical health (P < .001), and weight loss (P < .001) improved.
CONCLUSIONS
In our multispecialty tertiary center, initial P-ESWL followed by ERCP was safe in patients with coexisting pancreatic stones and PPCs and effective for stone clearance, main pancreatic duct drainage, and pain relief.
背景与目的
我们旨在研究胰腺体外冲击波碎石术（P-ESWL）用于清除慢性胰腺炎（CP）中与胰腺假性囊肿（PPCs）并存的大胰腺结石的效果。
方法
这是一项针对至少有1颗结石（≥5毫米）的CP患者进行的前瞻性研究。患者被分为PPC组（结石与PPCs并存）或对照组（单纯结石）。患者最初接受连续的P-ESWL治疗，随后进行内镜逆行胰胆管造影（ERCP）。主要结局是P-ESWL不良事件，次要结局是结石清除、长期疼痛缓解、生活质量评分改善以及PPC消退。
结果
2011年3月至2013年10月期间，共有849例患者（PPC组59例，对照组790例）接受了P-ESWL治疗。PPC组和对照组P-ESWL不良事件的发生率相似（11.86%对12.41%，P = 0.940）。在初始P-ESWL联合ERCP治疗后，PPC组患者结石完全清除、部分清除和未清除的发生率分别为67.24%、20.69%和12.07%，与对照组无显著差异（完全清除、部分清除和未清除分别为83.17%、10.40%和11.39%；P = 0.106）。59例PPC患者中的55例（93.22%）进行了中位时间为21.9个月（范围12.0 - 45.1个月）的随访。随访3个月和1年后，PPC分别在56.36%（31/55）和76.36%（42/55）的患者中消失。此外，分别有63.64%（35/55）和25.45%（14/55）的患者实现了完全和部分疼痛缓解。生活质量评分（P < 0.001）、身体健康评分（P < 0.001）和体重减轻（P < 0.001）均有所改善。
结论
在我们的多专科三级中心，初始P-ESWL后进行ERCP对胰腺结石与PPCs并存的患者是安全的，并且对结石清除、主胰管引流和疼痛缓解有效。
Zotero 插件