胰腺体外震波碎石术在疼痛性慢性胰腺炎合并胰管结石治疗中的应用

Application of pancreatic extracorporeal shock wave lithotripsy in painful chronic pancreatitis with pancreatic stones

目的探讨胰腺体外震波碎石术(P-ESWL)治疗疼痛性CP合并胰管结石的安全性和有效性。方法回顾性分析2019年8月至2021年12月间上海市浦东新区公利医院消化科诊治的113例行单独P-ESWL或P-ESWL联合ERCP治疗的疼痛性CP患者的临床资料,评估P-ESWL碎石成功率、术后并发症发生率、主胰管结石清除率,并随访患者的疼痛缓解程度。结果113例患者中单独P-ESWL治疗7例,P-ESWL联合ERCP治疗106例。碎石成功率为98.2%,P-ESWL并发症发生率为6.2%,主胰管结石完全清除率达75.2%。平均随访17.5(3~31)个月,84.1%患者疼痛完全缓解。单独P-ESWL和P-ESWL联合ERCP治疗后患者的疼痛频率和VAS评分较治疗前明显降低,体重和体重指数较治疗前显著增加,差异均有统计学意义(P值均<0.01)。结论P-ESWL对于疼痛性CP合并主胰管结石患者是安全、有效的。

Objective To explore the safety and efficacy of pancreatic extracorporeal shock wave lithotripsy(P-ESWL)in treating painful chronic pancreatitis patients with pancreatic stones.Methods The painful chronic pancreatitis patients receiving P-ESWL alone or P-ESWL combined with ERCP at Shanghai Pudong New Area Gongli Hospital from August 2019 to December 2021 were retrospectively analyzed.The success rate of stone fragmentation following P-ESWL,occurrence of postoperative complications,stone clearance rate of the main pancreatic duct and degree of pain relief in the follow-up were evaluated.Results Among 113 patients,7 patients were treated with P-ESWL alone and 106 patients were treated by P-ESWL combined with ERCP.The success rate of stone fragmentation was 98.2%.The occurrence of P-ESWL complications was 6.2%.Complete clearance of the main pancreatic duct stones was achieved in 75.2%of patients.With the mean follow-up of 17.5(3-31)months,complete pain relief was achieved in 84.1%of patients.The pain frequency and VAS score of patients treated with P-ESWL alone and P-ESWL combined with ERCP were obviously lower than those before treatment,and the body weight and body mass index were significantly higher than those before treatment,all with statistically significant differences(all P value<0.01).Conclusions P-ESWL is safe and effective for the management of painful chronic pancreatitis patients with main pancreatic duct stones.