Department of Gastroenterology and Hepatology, University Hospitals Leuven, Belgium.
Acta Gastroenterol Belg. 2021 Oct-Dec;84(4):620-626. doi: 10.51821/84.4.027.
Pain is the most frequent symptom in chronic pancreatitis (CP) and has an important impact on quality of life. One of its major pathophysiological mechanisms is ductal hypertension, caused by main pancreatic duct stones and/or strictures. In this article, we focus on extracorporeal shock wave lithotripsy (ESWL) as a treatment for main pancreatic duct stones, which have been reported in >50% of CP patients. ESWL uses acoustic pulses to generate compressive stress on the stones, resulting in their gradual fragmentation. In patients with radiopaque obstructive main pancreatic duct (MPD) stones larger than 5 mm, located in the pancreas head or body, ESWL improves ductal clearance, thereby relieving pain and improving quality of life. In case of insufficient ductal clearance or the presence of an MPD stricture, ESWL can be followed by endoscopic retrograde cholangiopancreatography (ERCP) to increase success rate. Alternatively, direct pancreaticoscopy with intracorporeal lithotripsy or surgery can be performed.
疼痛是慢性胰腺炎（CP）最常见的症状，对生活质量有重要影响。其主要病理生理机制之一是胰管高压，由主胰管结石和/或狭窄引起。本文重点介绍体外冲击波碎石术（ESWL）作为治疗主胰管结石的一种方法，＞50%的 CP 患者存在这种结石。ESWL 利用声波脉冲在结石上产生压缩应力，导致其逐渐碎裂。对于位于胰头部或体部、直径大于 5 毫米、不透射线的阻塞性主胰管（MPD）结石，ESWL 可改善胰管通畅性，从而缓解疼痛，改善生活质量。在胰管通畅性改善不充分或存在 MPD 狭窄的情况下，可以进行内镜逆行胰胆管造影（ERCP）以提高成功率。或者，可以进行经皮胰腺镜检查联合腔内碎石术或手术。
