慢性胰腺炎体外震波碎石后内镜取石最佳时机的临床分析

Clinical analysis of optimal timing of endoscopic stone extraction following extracorporeal shock wave lithotripsy in patients with chronic pancreatitis

目的评估体外震波碎石术（ESWL）联合内镜取石治疗慢性胰腺炎（CP）合并胰管结石的最佳时机。方法回顾性分析上海长海医院2014年2月至2015年2月接受ESWL联合内镜取石治疗的CP合并胰管结石患者170例，根据既往有无接受过ERCP治疗将患者分为A、B两组，再根据ESWL后内镜治疗的时机分为12 h内、12～36 h、36 h以上3个时间点组。评估各组胰管插管成功率、主胰管结石清除率和ERCP相关并发症。结果170例患者中107例既往接受过ERCP（A组），63例既往未接受过ERCP（B组）。总体上不同时机内镜取石的插管成功率、结石成功清除率的差异均无统计学意义。A组患者ESWL后12 h内、12～36 h、36 h以上ERCP取石的插管成功率分别为91.7%、95.2%、78.0%，结石成功清除率分别为91.7%、95.2% 、80.0%，差异均无统计学意义。B组患者ESWL后12 h内、12～36 h、36 h以上ERCP取石的插管成功率分别为66.7%、71.4%、96.3%，结石清除成功率分别为60.0%、76.2%、92.6%，36 h以上ERCP取石的胰管插管成功率及结石清除成功率均显著高于36 h内ERCP取石（P值分别为0.025、0.040）。不同时机取石对ERCP术后并发症无影响。结论既往已接受ERCP治疗的CP合并胰管结石患者在ESWL后可考虑早期内镜取石，既往未行ERCP治疗的患者采用延长ESWL后内镜取石的时机有助于提高治疗效果。

ObjectiveTo analyze the optimal timing of endoscopic stone extraction combined with extracorporeal shock wave lithotripsy （ESWL） in the treatment of chronic pancreatitis （CP） with pancreatic stones.MethodsData regarding 170 pancreatic stone patients receiving ESWL and endoscopic stone extraction at Shanghai Changhai Hospital from February 2014 to February 2015 were retrospectively analyzed. Based on the the prior history of endoscopic treatment, patients were divided into group A and B, and then sub-divided into three groups according to the timing of endoscopic intervention after ESWL including 〈12 h, 12-36 h and 〉36 h subgroup. The success of pancreatic ductal cannulation, clearance of stone in the main pancreatic duct, and ERCP-related complications were evaluated.ResultsAmong all the enrolled 170 patients, 107 previously received ERCP （group A） while the others didn′t （group B）. The overall success rate of cannulation and clearance rate of stones at different times showed no significant difference. The success rate and clearance rate in group A in 〈12 h, 12-36 h and 〉36 h subgroup were 91.7%, 95.2%, 78.0%, and 91.7%, 95.2%, 80.0%, and no significant difference existed. In group B, the success rate and clearance rate in 〈12 h, 12-36 h and 〉36 h subgroup were 66.7%, 71.4%, 96.3%, and 60.0%, 76.2%, 92.6%, and the differences were statistically different. The success rate and clearance rate of 〉36 h subgroup in group B were obviously higher than that in 〈12 hours （P=0.025） and 12-36 h subgroup （P=0.04）. The timing of endoscopic stone extraction did not influence ERCP-related complications.ConclusionsEarly endoscopic stone extraction after ESWL can be considered in patients with pancreatic stones who previously underwent ERCP. Delayed endoscopic stone extraction after ESWL is recommended in patients without prior ERCP, which can help promote the therapeutic efficacy.