体外冲击波碎石治疗慢性胰腺炎合并胰管结石的效果分析

Effect of pancreatic extracorporeal shock wave lithotripsy on chronic pancreatitis stones

目的探讨体外冲击波碎石(P-ESWL)治疗慢性胰腺炎合并胰管结石的效果及影响因素。方法回顾性收集2019年7月至2022年5月于西安交通大学第一附属医院肝胆外科就诊并接受P-ESWL治疗的81例慢性胰腺炎合并胰管结石患者的临床和影像学资料。男性55例(67.9%),女性26例(32.1%),年龄(47±15)岁(范围:17~77岁)。通过术前CT检查对结石进行测量,结石最大径[M(IQR)]为11.64(7.60)mm,结石CT值为869(571)HU。单发胰管结石32例(39.5%),多发胰管结石49例(60.5%)。评估P-ESWL治疗的有效性、腹痛缓解率及并发症发生情况。通过Student′s t检验、Mann Whitney U检验、χ^(2)检验或Fisher确切概率法对碎石有效组和碎石无效组间的特征进行比较。通过单因素和多因素Logistic回归分析筛选影响碎石效果的因素。结果81例慢性胰腺炎患者共接受144次P-ESWL治疗,平均1.78次/例(95%CI:1.60~1.96);其中38例(46.9%)患者接受联合内镜治疗。胰管结石被有效清除64例(79.0%)(碎石有效组),结石清除无效17例(21.0%)(碎石无效组)。伴有腹痛的61例患者中,碎石后腹痛缓解52例(85.2%)。碎石治疗后出现皮肤瘀斑45例(55.6%),窦性心动过缓23例(28.4%),术后发生急性胰腺炎3例(3.7%),石衔1例(1.2%),肝血肿1例(1.2%)。单因素及多因素Logistic回归分析结果显示,年龄(OR=0.92,95%CI:0.86~0.97)、结石最大径(OR=1.12,95%CI:1.02~1.24)和结石CT值(OR=1.44,95%CI:1.17~1.86)是碎石效果的影响因素。结论P-ESWL可用于治疗慢性胰腺炎合并主胰管结石;影响碎石效果的因素有患者年龄、结石最大径和结石CT值。

Objective To analyze the therapeutic effect and safety of pancreatic extracorporeal shock wave lithotripsy(P-ESWL)for patients with chronic pancreatitis complicated by stones of the pancreatic duct and to investigate the influencing factors.Methods A retrospective analysis was performed on clinical data from 81 patients with chronic pancreatitis complicated by pancreatic duct calculus treated with P-ESWL in the Department of Hepatobiliary Surgery,the First Affiliated Hospital of Xi′an Jiaotong University from July 2019 to May 2022.There were 55 males(67.9%)and 26 females(32.1%).The age was(47±15)years(range:17 to 77 years).The maximum diameter(M(IQR))of the stone was 11.64(7.60)mm,and the CT value of the stone was 869(571)HU.There were 32 patients(39.5%)with a single pancreatic duct stone and 49 patients(60.5%)with multiple pancreatic duct stones.The effectiveness,remission rate of abdominal pain,and complications of P-ESWL were evaluated.Student′s t test,Mann Whitney U test,χ^(2)test,or Fisher′s exact test was used to compare the characteristics between the effective and ineffective groups of lithotripsy.The factors influencing the effect of lithotripsy were analyzed by univariate and multivariate logistic regression analysis.Results Eighty-one patients with chronic pancreatitis were treated with P-ESWL 144 times,with an average of 1.78(95%CI:1.60 to 1.96)times per person.Among them,38 patients(46.9%)were treated with endoscopy.There were 64 cases(79.0%)with effective removal of pancreatic duct calculi and 17 cases(21.0%)with ineffective removal.Of the 61 patients with chronic pancreatitis accompanied by abdominal pain,52 cases(85.2%)had pain relief after lithotripsy.After lithotripsy treatment,45 patients(55.6%)developed skin ecchymosis,23 patients(28.4%)had sinus bradycardia,3 patients(3.7%)had acute pancreatitis,1 patient(1.2%)had a stone lesion,and 1 patient(1.2%)had a hepatic hematoma.Univariate and multivariate logistic regression analysis showed that the factors affecting the efficacy of lithotripsy included the age of patient(OR=0.92,95%CI:0.86 to 0.97),the maximum diameter of the stone(OR=1.12,95%CI:1.02 to 1.24)and the CT value of the stone(OR=1.44,95%CI:1.17 to 1.86).Conclusions P-ESWL is effective in the treatment of patients with chronic pancreatitis complicated by calculi of the main pancreatic duct.Factors affecting the efficacy of lithotripsy include patient′s age,maximum stone diameter,and CT value of calculi.