Robert J Y, Bretagne J F, Darnault P, Raoul J L, Siproudhis L, Heresbach D, Gosselin M
Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire de Pontchaillou, Rennes.
Gastroenterol Clin Biol. 1993;17(11):797-803.
A new therapeutic approach has been recently proposed in the management of chronic pancreatitis, including pancreatic endoscopic papillotomy and extracorporeal shock wave lithotripsy. The aim of this study was to assess the feasibility and the short--and long-term results of these procedures in a series of 16 patients aged 48.9 +/- 14 years. The indication for endoscopic treatment was pain in 15 cases and steatorrhea in one case. Pancreatic duct abnormalities included main pancreatic duct stenosis with calculi (9 cases), communicating pseudocysts upstream to a ductal stenosis or obstruction by calculi (4 cases), and isolated calculi (4 cases). Clinical response and morphologic parameters were used for analysis. Mean follow-up was 18.6 months (3.5 months to 7 years).
a) pancreatic endoscopic papillotomy, stents placement, and extracorporeal shock wave lithotripsy were successfully performed in 15 out of 16 cases, 1 out of 4 cases and 8 out of 8 cases, respectively; b) symptomatic improvement was observed in 11 of 15 patients with painful pancreatitis as relief was complete in 8, and partial in 3 cases. Pain relapse occurred in these latter 3 patients 4, 18 and 48 months after treatment; diabetes mellitus remained unchanged in all cases; c) diameter of the main pancreatic duct and pancreatic calcifications decreased in 8 of 15 cases and in 10 of 15 cases, respectively; pseudocyst disappeared in 2 of 4 cases; clinical improvement was significantly correlated with pancreatic morphology improvement. Clinical relapse was associated with calculi recurrence in every case. No complication was observed. Endoscopic papillotomy and extracorporeal shock wave lithotripsy are feasible in most cases of chronic pancreatitis. Relief of pain is obtained rapidly after treatment and seems to be correlated with the quality of pancreatic drainage.
最近在慢性胰腺炎的治疗中提出了一种新的治疗方法，包括胰内镜乳头切开术和体外冲击波碎石术。本研究的目的是评估在16例年龄为48.9±14岁的患者中这些手术的可行性以及短期和长期结果。内镜治疗的适应证为15例疼痛和1例脂肪泻。胰管异常包括主胰管狭窄伴结石（9例）、导管狭窄或结石梗阻上游的交通性假性囊肿（4例）和孤立结石（4例）。采用临床反应和形态学参数进行分析。平均随访时间为18.6个月（3.5个月至7年）。
a）16例中有15例、4例中有1例、8例中有8例分别成功进行了胰内镜乳头切开术、支架置入术和体外冲击波碎石术；b）15例疼痛性胰腺炎患者中有11例症状改善，其中8例完全缓解，3例部分缓解。后3例患者在治疗后4、18和48个月疼痛复发；所有病例中糖尿病均无变化；c）15例中有8例主胰管直径减小，15例中有10例胰腺钙化减小；4例中有2例假性囊肿消失；临床改善与胰腺形态改善显著相关。临床复发在每种情况下均与结石复发相关。未观察到并发症。胰内镜乳头切开术和体外冲击波碎石术在大多数慢性胰腺炎病例中是可行的。治疗后疼痛迅速缓解，似乎与胰管引流质量相关。
