BACKGROUND: Pancreatic duct stone (PDS) is a common complication of chronic pancreatitis. Surgery is a common therapeutic option for PDS. In this study we assessed the surgical procedures for PDS in patients with chro...BACKGROUND: Pancreatic duct stone (PDS) is a common complication of chronic pancreatitis. Surgery is a common therapeutic option for PDS. In this study we assessed the surgical procedures for PDS in patients with chronic pancreatitis at our hospital. METHOD: Between January 2004 and September 2009, medical records from 35 patients diagnosed with PDS associated with chronic pancreatitis were retrospectively reviewed and the patients were followed up for up to 67 months. RESULTS: The 35 patients underwent ultrasonography, computed tomography, or both, with an overall accuracy rate of 85.7%. Of these patients, 31 underwent the modified Puestow procedure, 2 underwent the Whipple procedure, 1 underwent simple stone removal by duct incision, and 1 underwent pancreatic abscess drainage. Of the 35 patients, 28 were followed up for 4-67 months. There was no postoperative death before discharge or during follow-up. After the modified Puestow procedure, abdominal pain was reduced in patients with complete or incomplete stone clearance (P>0.05). Steatorrhea and diabetes mellitus developed in several patients during a long-term follow-up. CONCLUSIONS: Surgery, especially the modified Puestow procedure, is effective and safe for patients with PDS associated with chronic pancreatitis. Decompression of intraductal pressure rather than complete clearance of all stones predicts postoperative outcome.展开更多
AIM:To assess the role of magnetic resonance cholangiopancreatography(MRCP) in detection of pancreatic duct stones(PDS) in patients with chronic pancreatitis(CP).METHODS:Clinical data of 78 CP patients who were treate...AIM:To assess the role of magnetic resonance cholangiopancreatography(MRCP) in detection of pancreatic duct stones(PDS) in patients with chronic pancreatitis(CP).METHODS:Clinical data of 78 CP patients who were treated at the First Affi liated Hospital of Xi'an Jiaotong University(China) between January 2004 and July 2008 were retrospectively analyzed.A predictive model of pancreatic duct stones was established through logistic regression and its effectiveness was verifi ed.Among these patients, MRCP was performed in 60 patients who served as a control group, while 44 patients with a higher predictive value than the entry threshold of the predictive model served as an experimental group.RESULTS:The positive rate of PDS in the 78 patients with CP was 19.2%(15/78).The predictive entry threshold of the predictive model was 5%(P < 0.05).The possibility of existence of PDS could be predicted according to the following 4 indexes:gastrointestinal symptoms, intermittent abdominal pain, diabetes mellitus(DM)/impaired glucose tolerance(IGT) and positive B-mode ultrasound results.The incidence of PDS in the experimental group was higher than that in the control group(P < 0.05).CONCLUSION:MRCP is strongly suggested for the detection of PDS in patients with gastrointestinal symptoms, intermittent abdominal pain, DM/IGT and positive B-mode ultrasound results.展开更多
BACKGROUND: Pancreatic duct stone is a rare disease, but there appears to be a rising trend in its incidence in recent years. Its pathogenesis remains unknown. The causes, diagnosis and treatment of pancreatic duct st...BACKGROUND: Pancreatic duct stone is a rare disease, but there appears to be a rising trend in its incidence in recent years. Its pathogenesis remains unknown. The causes, diagnosis and treatment of pancreatic duct stone are reviewed through a retrospective analysis of the cases treated in our hospital. METHODS: The medical records of 88 patients with pancreatic duct stone treated in West China Hospital, Sichuan University from January 1, 1998 to November 30, 2004 were analyzed retrospectively in terms of clinical characteristics, diagnosis and treatment. RESULTS: Epigastric pain was the most common symptom in the 88 patients with an average age of 45.44 +/- 6.72 years. Various other symptoms were also observed. Eighty-one patients were subjected to B-ultrasonography, 51 to CT, and 47 to magnetic resonance cholangiopancreatography (MRCP). Fifty-six patients (63.64%) were operated on, 25 (28.41%) were treated with Chinese and Western medicine, and 7 (7.95%) abandoned treatment. Chronic pancreatitis was pathologically confirmed in all patients undergoing operation. CONCLUSIONS: B-ultrasonography is the first choice to check for pancreatic duct stone, while MRCP proves instructively useful for the diagnosis and treatment. Chronic pancreatitis is the most important cause of pancreatic duct stone, but whether there is not a direct correlation between stone formation and alcohol abuse needs further study in China. Surgery is the most curative method for pancreatic duct stone patients with severe symptoms or suspected pancreatic carcinoma, while individual treatment is emphasized, and microtraumatic surgery may be a developing option for treating pancreatic stone.展开更多
Our aim was to record pancreaticobiliary endoscopic ultrasound(EUS) literature of the past 3 decades and evaluate its role based on a critical appraisal of published studies according to levels of evidence(LE).Origina...Our aim was to record pancreaticobiliary endoscopic ultrasound(EUS) literature of the past 3 decades and evaluate its role based on a critical appraisal of published studies according to levels of evidence(LE).Original research articles(randomized controlled trials,prospective and retrospective studies),meta-analyses,reviews and surveys pertinent to gastrointestinal EUS were included.All articles published until September 2011 were retrieved from PubMed and classified according to specific disease entities,anatomical subdivisions and therapeutic applications of EUS.The North of England evidencebased guidelines were used to determine LE.A total of 1089 pertinent articles were reviewed.Published research focused primarily on solid pancreatic neoplasms,followed by disorders of the extrahepatic biliary tree,pancreatic cystic lesions,therapeutic-interventional EUS,chronic and acute pancreatitis.A uniform observation in all six categories of articles was the predominance of LE Ⅲ studies followed by LE Ⅳ,Ⅱb,Ⅱa,Ⅰb and Ⅰ a,in descending order.EUS remains the most accurate method for detecting small(< 3 cm) pancreatic tumors,ampullary neoplasms and small(< 4 mm) bile duct stones,and the best test to define vascular invasion in pancreatic and peri-ampullary neoplasms.Detailed EUS imaging,along with biochemical and molecular cyst fluid analysis,improve the differentiation of pancreatic cysts and help predict their malignant potential.Early diagnosis of chronic pancreatitis appears feasible and reliable.Novel imaging techniques(contrast-enhanced EUS,elastography) seem promising for the evaluation of pancreatic cancer and autoimmune pancreatitis.Therapeutic applications currently involve pancreaticobiliary drainage and targeted fine needle injection-guided antitumor therapy.Despite the ongoing development of extra-corporeal imaging modalities,such as computed tomography,magnetic resonance imaging,and positron emission tomography,EUS still holds a leading role in the investigation of the pancreaticobiliary area.The major challenge of EUS evolution is its expanding therapeutic potential towards an effective and minimally invasive management of complex pancreaticobiliary disorders.展开更多
文摘BACKGROUND: Pancreatic duct stone (PDS) is a common complication of chronic pancreatitis. Surgery is a common therapeutic option for PDS. In this study we assessed the surgical procedures for PDS in patients with chronic pancreatitis at our hospital. METHOD: Between January 2004 and September 2009, medical records from 35 patients diagnosed with PDS associated with chronic pancreatitis were retrospectively reviewed and the patients were followed up for up to 67 months. RESULTS: The 35 patients underwent ultrasonography, computed tomography, or both, with an overall accuracy rate of 85.7%. Of these patients, 31 underwent the modified Puestow procedure, 2 underwent the Whipple procedure, 1 underwent simple stone removal by duct incision, and 1 underwent pancreatic abscess drainage. Of the 35 patients, 28 were followed up for 4-67 months. There was no postoperative death before discharge or during follow-up. After the modified Puestow procedure, abdominal pain was reduced in patients with complete or incomplete stone clearance (P>0.05). Steatorrhea and diabetes mellitus developed in several patients during a long-term follow-up. CONCLUSIONS: Surgery, especially the modified Puestow procedure, is effective and safe for patients with PDS associated with chronic pancreatitis. Decompression of intraductal pressure rather than complete clearance of all stones predicts postoperative outcome.
文摘AIM:To assess the role of magnetic resonance cholangiopancreatography(MRCP) in detection of pancreatic duct stones(PDS) in patients with chronic pancreatitis(CP).METHODS:Clinical data of 78 CP patients who were treated at the First Affi liated Hospital of Xi'an Jiaotong University(China) between January 2004 and July 2008 were retrospectively analyzed.A predictive model of pancreatic duct stones was established through logistic regression and its effectiveness was verifi ed.Among these patients, MRCP was performed in 60 patients who served as a control group, while 44 patients with a higher predictive value than the entry threshold of the predictive model served as an experimental group.RESULTS:The positive rate of PDS in the 78 patients with CP was 19.2%(15/78).The predictive entry threshold of the predictive model was 5%(P < 0.05).The possibility of existence of PDS could be predicted according to the following 4 indexes:gastrointestinal symptoms, intermittent abdominal pain, diabetes mellitus(DM)/impaired glucose tolerance(IGT) and positive B-mode ultrasound results.The incidence of PDS in the experimental group was higher than that in the control group(P < 0.05).CONCLUSION:MRCP is strongly suggested for the detection of PDS in patients with gastrointestinal symptoms, intermittent abdominal pain, DM/IGT and positive B-mode ultrasound results.
文摘BACKGROUND: Pancreatic duct stone is a rare disease, but there appears to be a rising trend in its incidence in recent years. Its pathogenesis remains unknown. The causes, diagnosis and treatment of pancreatic duct stone are reviewed through a retrospective analysis of the cases treated in our hospital. METHODS: The medical records of 88 patients with pancreatic duct stone treated in West China Hospital, Sichuan University from January 1, 1998 to November 30, 2004 were analyzed retrospectively in terms of clinical characteristics, diagnosis and treatment. RESULTS: Epigastric pain was the most common symptom in the 88 patients with an average age of 45.44 +/- 6.72 years. Various other symptoms were also observed. Eighty-one patients were subjected to B-ultrasonography, 51 to CT, and 47 to magnetic resonance cholangiopancreatography (MRCP). Fifty-six patients (63.64%) were operated on, 25 (28.41%) were treated with Chinese and Western medicine, and 7 (7.95%) abandoned treatment. Chronic pancreatitis was pathologically confirmed in all patients undergoing operation. CONCLUSIONS: B-ultrasonography is the first choice to check for pancreatic duct stone, while MRCP proves instructively useful for the diagnosis and treatment. Chronic pancreatitis is the most important cause of pancreatic duct stone, but whether there is not a direct correlation between stone formation and alcohol abuse needs further study in China. Surgery is the most curative method for pancreatic duct stone patients with severe symptoms or suspected pancreatic carcinoma, while individual treatment is emphasized, and microtraumatic surgery may be a developing option for treating pancreatic stone.
文摘Our aim was to record pancreaticobiliary endoscopic ultrasound(EUS) literature of the past 3 decades and evaluate its role based on a critical appraisal of published studies according to levels of evidence(LE).Original research articles(randomized controlled trials,prospective and retrospective studies),meta-analyses,reviews and surveys pertinent to gastrointestinal EUS were included.All articles published until September 2011 were retrieved from PubMed and classified according to specific disease entities,anatomical subdivisions and therapeutic applications of EUS.The North of England evidencebased guidelines were used to determine LE.A total of 1089 pertinent articles were reviewed.Published research focused primarily on solid pancreatic neoplasms,followed by disorders of the extrahepatic biliary tree,pancreatic cystic lesions,therapeutic-interventional EUS,chronic and acute pancreatitis.A uniform observation in all six categories of articles was the predominance of LE Ⅲ studies followed by LE Ⅳ,Ⅱb,Ⅱa,Ⅰb and Ⅰ a,in descending order.EUS remains the most accurate method for detecting small(< 3 cm) pancreatic tumors,ampullary neoplasms and small(< 4 mm) bile duct stones,and the best test to define vascular invasion in pancreatic and peri-ampullary neoplasms.Detailed EUS imaging,along with biochemical and molecular cyst fluid analysis,improve the differentiation of pancreatic cysts and help predict their malignant potential.Early diagnosis of chronic pancreatitis appears feasible and reliable.Novel imaging techniques(contrast-enhanced EUS,elastography) seem promising for the evaluation of pancreatic cancer and autoimmune pancreatitis.Therapeutic applications currently involve pancreaticobiliary drainage and targeted fine needle injection-guided antitumor therapy.Despite the ongoing development of extra-corporeal imaging modalities,such as computed tomography,magnetic resonance imaging,and positron emission tomography,EUS still holds a leading role in the investigation of the pancreaticobiliary area.The major challenge of EUS evolution is its expanding therapeutic potential towards an effective and minimally invasive management of complex pancreaticobiliary disorders.
