Schneider H T, May A, Benninger J, Rabenstein T, Hahn E G, Katalinic A, Ell C
Department of Medicine, University of Erlangen-Nuremberg, Germany.
Am J Gastroenterol. 1994 Nov;89(11):2042-8.
The efficacy of extracorporeal piezoelectric shock wave lithotripsy in patients with obstructing pancreatic duct stones was investigated.
Fifty patients suffering from chronic pancreatitis and obstructing pancreatolithiasis were treated by ESWL (Piezolith 2500). Shock wave treatment was administered, inasmuch as the stones were not extractable by initially applied endoscopic measures.
A total of 119 (2.4 +/- 1.4, range 1-7) lithotripsy sessions were conducted; only mild sedation/analgesia was used. Optimum targeting of the concrements in the shock wave focus was achieved in 17 (14%) treatment sessions with ultrasonography only; it was achieved in 65 (55%) cases by fluoroscopy and, in further 37 (31%) sessions by using both localization systems. Stone fragmentation was successful in 43 (86%) patients. Nineteen (38%) patients achieved spontaneous stone discharge after shock wave lithotripsy. In 11 (22%) cases, it was possible to remove all fragments endoscopically; residual fragments remained in 20 (40%) patients. Severe complications attributable to shock wave application did not occur. During follow-up, six patients had to be referred to surgery; two male patients died of specific diabetic complications and pleural mesothelioma, respectively. Thirty-five (90%) of 39 patients whose conditions were followed for 2-50 (20 +/- 14) months reported improvement of their pain sensations. Six (15%) patients required endoscopic treatment, including ESWL in five of those patients, to be repeated due to recurrent formation of calculi in the main pancreatic duct, which was again successful in five of the six patients.
Piezoelectric shock wave lithotripsy offers a basis for safe and effective fragmentation of pancreatic stones and facilitates endoscopic procedures. Most of the patients with obstructing pancreatic stones became stonefree and showed a significant reduction of pain.
研究体外压电冲击波碎石术治疗胰管梗阻性结石患者的疗效。
50例慢性胰腺炎合并胰管结石梗阻患者接受了ESWL（Piezolith 2500）治疗。由于最初采用的内镜措施无法取出结石，因此进行了冲击波治疗。
共进行了119次（2.4±1.4，范围1 - 7）碎石治疗；仅使用了轻度镇静/镇痛。仅通过超声在17次（14%）治疗中实现了结石在冲击波焦点的最佳定位；通过荧光透视在65例（55%）病例中实现了最佳定位，在另外37次（31%）治疗中通过使用两种定位系统实现了最佳定位。43例（86%）患者结石破碎成功。19例（38%）患者在冲击波碎石术后实现了结石自然排出。在11例（22%）病例中，可以通过内镜取出所有碎片；20例（40%）患者残留有碎片。未发生因冲击波应用导致的严重并发症。在随访期间，6例患者不得不接受手术治疗；2例男性患者分别死于特定的糖尿病并发症和胸膜间皮瘤。39例病情随访2 - 50（20±14）个月的患者中，35例（90%）报告疼痛感觉有所改善。6例（15%）患者因主胰管结石复发需要内镜治疗，其中5例患者再次接受了ESWL治疗，6例患者中有5例再次治疗成功。
压电冲击波碎石术为安全有效地破碎胰石提供了基础，并便于进行内镜操作。大多数胰管梗阻性结石患者结石清除，疼痛明显减轻。
