Taki N, Nakazawa S, Yamao K, Okushima K, Yoshino J, Inui K, Yamachika H, Kanemaki N, Wakabayashi T, Iwase T, Miyoshi H, Kobayashi T, Sugiyama K, Nishio H, Nakamura Y, Mizutani S, Kato R, Takashima T, Asai N, Watanabe S
Department of Internal Medicine, Second Teaching Hospital, Fujita Health University, School of Medicine.
Nihon Shokakibyo Gakkai Zasshi. 1997 Feb;94(2):101-10.
30 patients with main pancreatic duct stones were treated by ESWL. In 18 of 22 patients who had not previously undergone endoscopic pancreatic sphincterotomy (EPST) or endoscopic sphincterotomy (EST), the stone fragments disappeared after ESWL. The fragments were removed endoscopically in the remaining 4 cases. Complete clearance was achieved in 8 cases with endoscopically unextractable stones by ESWL. After the ESWL procedure, absolute relief from pain was reported by in 19 of 22 patients with abdominal complaints. Serum amylase levels decreased significantly, and dilatation of the main pancreatic duct (MPD) was reduced. In the medium-term follow-up period, pancreatic exocrine function and endocrine function had a possibility to be preserved. One case of pancreatic cancer and one case of an intraductal papillary tumor of the pancreas were found, indicating that careful observation is necessary even after complete removal of pancreatic stones. In cases of Santorini duct dominant, multiple stones, or stricture of the MPD, ESWL should be combined with EPST and endoscopic stenting for preventing recurrence of acute pancreatitis and pancreatic stones. In conclusion, ESWL is the first choice of treatment for pancreatolithiasis and useful procedure and the limited complications.
30例主胰管结石患者接受了体外冲击波碎石术（ESWL）治疗。在22例此前未接受过内镜下胰管括约肌切开术（EPST）或内镜括约肌切开术（EST）的患者中，18例患者的结石碎片在ESWL后消失。其余4例患者的结石碎片通过内镜取出。8例内镜无法取出结石的患者经ESWL后实现了结石完全清除。ESWL术后，22例有腹部症状的患者中有19例报告疼痛完全缓解。血清淀粉酶水平显著下降，主胰管（MPD）扩张减轻。在中期随访期间，胰腺外分泌功能和内分泌功能有可能得以保留。发现1例胰腺癌和1例胰腺导管内乳头状瘤，这表明即使在胰腺结石完全清除后仍需仔细观察。对于存在副胰管主导、多发结石或MPD狭窄的病例，ESWL应与EPST和内镜支架置入术联合应用，以预防急性胰腺炎和胰腺结石复发。总之，ESWL是治疗胰石症的首选方法，是一种有效的治疗手段，且并发症有限。
