ERCP联合体外震波碎石术在慢性胰腺炎合并胰管结石治疗中的应用

Application of ERCP and extracorpareal shock wave lithotripsy in the treatment of chronic pancreatitis with pancreatic duct stones

目的探讨内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatograph,ERCP)及体外震波碎石术(extracorporeal shock wave lithotripsy,ESWL)在胰管结石治疗中的应用价值。方法回顾性收集2010年1月至2021年8月期间笔者所在医院消化内科收治的慢性胰腺炎合并胰管结石患者28例,根据患者处理方式分为ERCP直接取石组和ESWL联合ERCP取石组,比较2组患者的治疗效果,包括取石成功率、ERCP术后并发症、术后症状缓解情况等。结果28例患者中行ERCP直接取石19例,ESWL联合ERCP取石9例。ERCP直接取石组患者结石完全清除7例(36.84%),部分清除1例(5.26%),清除失败、仅放置支架引流11例(57.89%);术后6 h白细胞升高5例(26.32%)、C反应蛋白升高4例(21.05%);术后诊断为ERCP术后胰腺炎3例(15.79%)、高淀粉酶血症2例(10.53%);术后随访3~6个月腹痛症状完全缓解14例(73.68%),术后6个月17例患者体质量有所增加(89.47%)。ESWL联合ERCP取石患者结石完全清除5例(55.56%),部分清除3例(33.33%),清除失败、仅放置支架引流1例(11.11%)。术后6 h白细胞升高1例(11.11%)、C反应蛋白升高1例(11.11%);术后发生ERCP术后胰腺炎1例(11.11%),1例患者(11.11%)出现ESWL过程中腹痛及一过性血尿,3 d后自行缓解。术后随访3~6个月腹痛症状完全缓解9例(100%),术后6个月9例患者体质量均增加(100%)。ESWL联合ERCP取石组的结石清除率高于ERCP直接取石组(P=0.033),但2组在术后并发症、腹痛完全缓解和体质量增加方面比较差异无统计学意义(P>0.05)。结论ESWL联合ERCP治疗慢性胰腺炎合并胰管结石的取石效果较ERCP直接取石更优,可有效清除结石,安全有效。

Objective To explore the value of endoscopic retrograde cholangiopancreatograph(ERCP)and extracorporeal shock wave lithotripsy(ESWL)in the treatment of pancreatic duct stones.Methods A retrospective collection of 28 patients with chronic pancreatitis and pancreatic duct stones admitted to the Department of Gastroenterology from January 2010 to August 2021 was performed.According to the treatment of patients,they were divided into ERCP direct stone extraction group and ESWL combined ERCP stone extraction group.We compared the treatment effects of the two groups of patients,including the success rate of stone extraction,postoperative complications of ERCP,postoperative symptom improvement,and so on.Results Among the 28 patients,19 cases underwent ERCP direct stone extraction,and 9 cases underwent ESWL combined with ERCP stone extraction.In the ERCP direct stone extraction group,7 cases(36.84%)were completely extracted,1 case was partially extracted(5.26%),and 11 cases(57.89%)failed to extract and only placed stents and drained;5 cases(26.32%)had elevated white blood cells at 6 hours postoperatively,C-reactive protein increased in 4 cases(21.05%),3 cases(15.79%)were diagnosed as ERCP-related pancreatitis,and 2 cases(10.53%)were diagnosed as hyperamylaseemia.The abdominal pain symptoms were completely relieved in 14 cases(73.68%)during a follow-up period of 3 to 6 months.The body mass of 17 cases(89.47%)increased in the 6 months after stone extraction.ESWL combined with ERCP had complete stone extraction in 5 cases(55.56%),partial stone extraction in 3 cases(33.33%),and failure in stone extraction and only stent drainage in 1 case(11.11%).One case(11.11%)had elevated white blood cells at 6 hours postoperatively,and 1 case(11.11%)had elevated C-reactive protein.One case(11.11%)was diagnosed with ERCP-related pancreatitis.One case(11.11%)got abdominal pain and transient hematuria during ESWL,which resolved spontaneously 3 days later.After 3 to 6 months of follow-up,9 patients(100%)had complete relief of abdominal pain symptoms,and the body mass of 9 patients(100%)increased in the 6 months after stone extraction.The stone clearance rate of the ESWL combined with ERCP stone extraction group was higher than that of the ERCP direct stone extraction group(P=0.033),but there was no statistically significant difference between the two groups in terms of ERCP-related complications,relief of abdominal pain,and weight gain(P>0.05).Conclusion ESWL combined with ERCP in the treatment of chronic pancreatitis complicated with pancreatic duct stone extraction is more effective than ERCP direct stone extraction.