目的 评价ERCP联合ESWL治疗胰管结石的效果。方法 2008年1月～2009年12月在我院经影像学确诊的12例胰管结石患者接受了ERCP联合ESWL治疗。先行ERCP以了解胰管形态改变并放置胰管支架;续行ESWL,依结石形态及密度了解碎石效果,对碎石不满意者重复ESWL;6～8周后再行ERCP取石。结果 所有患者全部碎石成功(根据结石密度和体积变化);其中,1例行ESWL后结石完全排净,5例ESWL后经内镜治疗结石被完全清除,1例结石部分清除,1例取石失败,2例碎石后失访。治疗期间未出现严重并发症。结论 ESWL对胰管结石碎石效果好,但单纯ESWL仅部分患者结石可自行排出;ESWL后结合内镜取石治疗,能提高胰管结石清除效果。
Objective To evaluate the efficacy of ESWL combined with ERCP for the treatment of pancreatic duct stones (PDSs).Methods 12 patients with PDSs confirmed by ultrasound and radiography received treatment in our hospital from January 2008 to March 2010.ERCP was first performed to determine the ductal morphology,the location and number of stones,which pancreatic sphincterotomy and stenting were performed depending on the condition of the patients.ESWL was performed in all patients and repeated depending on stone changes.6-8 weeks after ESWL,therapeutic ERCP for balloon dilation and stone extraction was performed to manage residual stones.Pancreatic stents were placed after stone extraction.Results ESWL was performed and stone fragmentation was achieved in all patients.Spontaneous stone clearance after ESWL alone occurred in one patient.Complete duct clearance was achieved in 7 patients by therapeutic ERCP; partial duct clearance was achieved in one patient; and duct clearance failed in one patients.Of the 12 patients,two patients failed to follow-up after ESWL.No procedure-related major complication occurred.Conclusions ESWL is effective for PDS fragmentation and can be repeated.A high rate of successful PDS clearance can be achieved when therapeutic ERCP is followed by ESWL
[1] Sarles H,Bernard JP,Gullo L.Pathogenesis of chronic pancreatitis[J].Gut,1990,31(6):629-632.
[2] Maydeo A,Bhandari S,Bapat M.Endoscopic balloon sphincteroplasty for extraction of large radiolucent pancreatic duct stones (with videos)[J].Gastrointestinal Endosc,2009,70(4):798- 802.
[3] Machiki Y,Nimura Y,Kamiya J,Kamiya J,Kondo S,Nagino M,Miyachi M,Kanai M.Clinicopathologic study on pancreatic cancer associated with pancreatic stones[J].Int J Pancreatol,1997,22(3):187-191.
[4] Inui K,Tazuma S,Yamaguchi T,et al.Treatment of pancreatic stones with extracorporeal shock wave lithotripsy:result of a multicenter survey[J].Pancreas,2005,30(1):26-30.
[5] Smits ME,Rauws EAJ,Tytgat GNJ,et al..Endoscopic treatment of pancreatic stones in patients with chronic pancreatitis[J].Gastrointest Endosc,1996,43(6):556-560.
[6] Dumonceau JM,Deviere J,Le Moine O,et al..Endoscopic pancreatic drainage in chronic pancreatitis associated with ductal stones:long-term results[J].Gastrointest Endosc,1996,43(6):547-555.
[7] Heyries L,Sahel J.Endoscopic treatment of chronic pancreatitis[J].World J Gastroenterol,2007,13(46):6127-6133.
[8] Farnbacher MJ,Schoen C,Rabenstein T,et al.Pancreatic duct stones in chronic pancreatitis:criteria for treatment intensity and success[J].Gastrointest Endosc,2002,56(4):501-506.
[9] Costamagna G,Gabbrielli A,Mutignani M,et al.Extracorporeal shock wave lithotripsy of pancreatic stones in chronic pancreatitis:immediate and mediumterm results[J].Gastrointest Endosc,1997,46(3):231-236.
[10] Delhaye M,Vandermeeren A,Baize M,et al.Extracorporeal shock-wave lithotripsy of pancreatic calculi[J].Gastroenterology,1992,102(2):610-620.
[11] Kozarek RA,Brandabur JJ,Ball TJ,et al.Clinical outcomes in patients who undergo extracorporeal shock wave lithotripsy for chronic calcific pancreatitis[J].Gastrointest Endosc,2002,56(4):496-500.
[12] Sauerbruch T,Holl J,Sackmann M,et al.Disintegration of pancreatic duct stone with extracorporeal shock waves in a patient with chronic pancreatitis[J].Endoscopy,1987,19(5):207-208.
[13] Sauerbruch T,Holl J,Sackmann M,et al.Extracorporeal shock wave lithotripsy of pancreatic stones[J].Gut,1989,30(10):1406-1411.
