检索历史 清除

目的 探讨体外震波碎石术(ESWL)治疗慢性胰腺炎(CP)胰管结石的适应证、治疗流程、麻醉方式、安全性和有效性.方法 观察2011年3月至7月长海医院消化内科诊治的CP患者(伴有结石直径＞0.5 cm).ESWL采用第三代体外震波碎石系统,通过X线定位结石,每个震波疗程不超过5000次冲击波,连续每日一次震波治疗,直至结石粉碎,再行ERCP取石.结果 5个月共治疗100例患者,84例曾行ERCP治疗,其中造影及深插管失败41例.多发结石83例,阳性结石占95％,阴性结石占2％,混合性结石占3％.完成ESWL治疗175例次,其中43％患者行2次以上ESWL.麻醉方式以静脉镇静为主(96％).ESWL治疗后行ERCP取石,插管成功96例,其中既往ERCP失败的41例中,ESWL治疗后成功插管37例.碎石成功率达100％.ESWL联合ERCP的结石完全清除率达78％,并发症发生率为2.28％,均为轻症.结论 ESWL安全有效,是CP微创治疗体系中不可或缺的技术之一.

Objective To probe the indication,treatment algorithm,anesthesia method,safety and efficacy of extracorporeal shockwave lithotripsy (ESWL) in combination with endoscopic retrograde cholangiopancreatography (ERCP) for pancreatic duct stones.Methods The patients with chronic pancreatitis and large pancreatic duct stones ( ＞ 5 mm diameter) and receiving ESWL and ERCP between March and July 2011 in Changhai Hospital were prospective studied.The third generation of extracorporeal shockwave lithotripsy was applied in ESWL,and the localization of stone was determined by X-ray.No more than 5000 shocks were given per session,and ESWL was performed continuously till the calculi were fragmented,and then was cleared by ERCP.Results A total of 100 patients underwent ESWL during the 5 months,among whom 84 patients received ERCP treatment and 41 cases failed to deep cannulation (41/84,48.8％ ).Multiple stones were seen in 83 patients.Ninety five patients had radio-opaque stones,two patients had radiolucent calculi,while three patients had both radio-opaque and radiolucent stones.Seventy five percent,14％ and 11％ stones were located in pancreatic head,pancreatic head and body,pancreatic body and tail,respectively.A total of 175 ESWL procedures were performed,43 patients needed 2 or more sessions for successful fragmentation.Anesthesia method was mainly intravenous sedation,accounting for 96％ (168/175).ERCP was successful in 96 patients after ESWL,only 4 patients failed after ESWL. Forty one cases which failed ERCP procedures before ESWL underwent ERCP,and 37 patients (90.2％) achieved successful cannulation.Successful fragmentation rate was 100％.Complete clearance was achieved in 78 patients,and complication rate of post-ERCP pancreatitis,fever was 1.71％ (n =3 ),0.57％ (n =1 ),and the overall complication rate was 2.28％.Conclusions ESWL is an effective,safe and necessary modality for fragmentation of large PD stones in the management of minimal invasive treatment of chronic pancreatitis.