Yi Jinhui, Xu Jinjie, Hu Lianghao
Department of Gastroenterology, Changhai Hospital , Naval Medical University, Shanghai, China.
Shanghai Institute of Pancreatic Diseases, Shanghai, China.
Med Rev (2021). 2024 Jul 15;4(6):510-521. doi: 10.1515/mr-2024-0001. eCollection 2024 Dec.
Chronic pancreatitis (CP) is characterized by irreversible destruction of pancreatic parenchyma, inflammatory cell infiltration and progressive fibrosis of pancreatic tissue. Obstruction of pancreatic duct by pancreatic stone is the common pathological change in the course of CP with the incidence of over 50 % at the diagnosis of CP. These ductal stones would cause pancreatic parenchymal hypertension and local ischemia, which was eventually followed by recurrent episodes of painful pancreatitis or other manifestations of pancreatic exocrine and endocrine insufficiency. Removing pancreatic stones has been confirmed as the core to reduce pressure, improve drainage and lessen pain. Surgical therapy achieves satisfying pain relief with more complications, higher cost and less repeatability compared with endoscopic therapy. Endoscopic retrograde cholangiopancreatography, which used to be the standard endoscopic therapy for pancreatic stones, would fail if these stones are large or complex, while pancreatic extracorporeal shock wave lithotripsy (P-ESWL), which has been applied since 1987, could overcome this problem. Up to now, a large number of guidelines have recommended the P-ESWL as the first-line treatment strategy for radiopaque obstructive main pancreatic duct stones larger than 5 mm located in the head/body of the pancreas, and P-ESWL had completely changed the traditional treatment model for CP patients with pancreatic stones. In this article, we will focus on the technical progress, efficacy, safety and potential research areas of P-ESWL, we also give us suggestions for lithotripters improvement.
慢性胰腺炎（CP）的特征是胰腺实质的不可逆破坏、炎症细胞浸润以及胰腺组织的进行性纤维化。胰石阻塞胰管是CP病程中的常见病理变化，在CP诊断时发生率超过50%。这些导管结石会导致胰腺实质高压和局部缺血，最终引发复发性疼痛性胰腺炎或胰腺外分泌和内分泌功能不全的其他表现。去除胰石已被确认为减轻压力、改善引流和减轻疼痛的核心。与内镜治疗相比，手术治疗能实现令人满意的疼痛缓解，但并发症更多、成本更高且可重复性更低。内镜逆行胰胆管造影术曾是治疗胰石的标准内镜治疗方法，但如果结石较大或复杂则会失败，而自1987年以来应用的体外震波碎石术（P-ESWL）可以克服这一问题。到目前为止，大量指南已推荐P-ESWL作为位于胰头/体部、直径大于5mm的不透X线的阻塞性主胰管结石的一线治疗策略，P-ESWL彻底改变了CP合并胰石患者的传统治疗模式。在本文中，我们将重点关注P-ESWL的技术进展、疗效、安全性及潜在研究领域，同时也对碎石机的改进提出建议。
