Dumonceau J M, Devière J, Le Moine O, Delhaye M, Vandermeeren A, Baize M, Van Gansbeke D, Cremer M
Department of Gastroenterology/Hepatopancreatology, Erasme University Hospital, Brussels, Belgium.
Gastrointest Endosc. 1996 Jun;43(6):547-55. doi: 10.1016/s0016-5107(96)70189-x.
In severe chronic pancreatitis associated with intraductal stones, therapeutic endoscopy aims to reduce increased intraductal pressure by pancreatic sphincterotomy and stone clearance.
Results of treatment were evaluated in 70 new patients who underwent pancreatic sphincterotomy and attempted stone removal. Technical results and frequency of pain relief and recurrence are compared.
Complete ductal clearance of calculi was obtained in 50% of cases. Immediate clinical improvement occurred in 95% of patients with painful attacks. No severe complications or mortality occurred. Fifty-four percent of all patients with painful chronic pancreatitis did not experience any pain recurrence within 2 years. Associations found to be statistically significant by multivariate analysis were ductal clearance and extracorporeal shock wave lithotripsy, pain disappearance and ductal clearance, pain recurrence and long evolution, and severe disease before treatment and presence of a ductal substenosis.
In this subset of patients our results indicate that the pain of chronic pancreatitis is mainly related to increased intraductal pressure. Endoscopic management appears to be a safe, conservative, alternative to surgery. The best results are obtained when it is performed early in the course of calcifying chronic pancreatitis.
在伴有胰管结石的严重慢性胰腺炎中，治疗性内镜检查旨在通过胰管括约肌切开术和结石清除来降低升高的胰管内压力。
对70例接受胰管括约肌切开术并尝试取石的新患者的治疗结果进行评估。比较技术结果以及疼痛缓解和复发的频率。
50%的病例实现了结石的完全清除。95%有疼痛发作的患者临床症状立即改善。未发生严重并发症或死亡。所有疼痛性慢性胰腺炎患者中有54%在2年内未出现任何疼痛复发。多变量分析发现具有统计学意义的关联因素有：导管清除和体外冲击波碎石术、疼痛消失和导管清除、疼痛复发和病程长，以及治疗前的严重疾病和导管狭窄。
在这部分患者中，我们的结果表明慢性胰腺炎的疼痛主要与胰管内压力升高有关。内镜治疗似乎是一种安全、保守的手术替代方法。在钙化性慢性胰腺炎病程早期进行内镜治疗可获得最佳效果。
Zotero 插件