经内镜治疗胰管结石的临床研究

CLINICAL STUDY ABOUT ENDOSCOPIC TREATMENT OF PANCREATIC DUCTAL STONES

为探讨胰管结石(PDS)内镜治疗的临床疗效 ,回顾分析了长海医院 1998年 1月～ 2 0 0 1年 12月经内镜治疗的 31例PDS病人。其中行内镜下乳头括约肌切开术 (EPT)、内镜下胰管括约肌切开术 (EPS)成功取石 10例 ;行EPS加体外震波碎石术 (ESWL)及ESWL加胰管内支架引流术 (ERPD)各 1例 ,且于半年后复查胰石消失 ;伴胰管狭窄者行ERPD 14例 ,行EPS+ERPD 4例 ,其中 4例置管后因症状复发或伴胰腺癌而接受手术治疗 ,1例因胰管狭窄严重内镜治疗失败。全部操作成功率为 96 8% ,腹痛近期缓解率 90 % ;30例随访 1～2 5个月 ,腹痛远期缓解率 70 4 % ,体重、脂肪泻等胰腺外分泌功能不足表现均有不同程度改善。早期并发症主要为高淀粉酶血症、轻度胰腺炎 ,经常规处理后均恢复正常 ;3例因支架阻塞更换支架。提示行EPS取石及ESWL、ERPD治疗PDS疗效确切 ,且操作简便、并发症少。

To evaluate the effect of endoscopic treatment of pancreatic ductal stones (PDS), 31 patients with PDS treated in our hospital from January 1998 to Octomber 2001 were analyzed retrospectively. PDS were successfully extracted in 10 patients by endoscopic papillotomy (EPT) or endoscopic pancreatic sphincterotomy (EPS). In 2 patients, one was treated with extracorporeal shock wave lithotripsy (ESWL) and endoscopic retrograde pancreatic drainage (ERPD), another with EPS and ESWL, the PDS were all disappeared in 6 months. Fourteen patients with pancreatic ductal stricture were treated with ERPD, and 4 with EPS+ERPD. However, 4 patients were subjected to operation for pancreatic carcinoma and recurrent symptom. Only one of them failed owing to severe pancreatic ductal stricture. The success rate of the procedure was 96 8%, and the remission rate of abdominal pain was 90% shortly after operation and 70 4% in the follow up interval. The body weight and pancreatic exocrine function were also improved. But the stent occlusion was found in 3 patients and their stents were changed. So endoscopic therapy such as EPS, ESWL, and ERPD are effective and safe methods in treatment of PDS.