Long-term clinical outcomes of extracorporeal shockwave lithotripsy in painful chronic calcific pancreatitis
Long-term clinical outcomes of extracorporeal shockwave lithotripsy in painful chronic calcific pancreatitis
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DOI：
10.1016/j.gie.2013.05.012
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发表时间：
2013-11-01
影响因子：
7.7
通讯作者：
Rao, Guduru Venkat
中科院分区：
文献类型：
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作者：
Tandan, Manu;Reddy, Duvvur Nageshwar;Rao, Guduru Venkat
背景：体外冲击波碎石术（ESWL）治疗特发性钙化性胰腺炎（CP）患者大胰管结石的长期结果尚不明确。目的：评价ESWL治疗特发性cp患者的中期和长期疗效。回顾图表审查。环境：内窥镜检查和胃肠道疾病的高容量三级护理中心。患者：对636例特发性CP患者进行ESWL和ERCP随访。患者分为中期（24 ~ 60个月）和长期（60 ~ 60个月）随访组。干预：ESWL和ERCP。主要结果测量：疼痛的改善、镇痛药的使用、因疼痛住院、结石复发、额外干预的需要和生活质量。结果：2004 - 2009年间1006例接受体外冲击波碎石术的患者中，636例随访时间最长为96个月。中期随访组364例，长期随访组272例。经ESWL和ERCP治疗后，250例患者（68.7%）无疼痛，94例患者（25.4%）有轻度至中度疼痛，20例患者（5.5%）有重度疼痛。在长期组中，164例患者（60.3%）无疼痛，97例患者（35.7%）有轻度或中度疼痛发作，而11例患者（4.04%）有阵发性剧烈疼痛。中期随访组结石复发51例（14.01%），长期随访组结石复发62例（22.8%）。两组患者的生活质量均有显著改善。局限性：回顾性研究，单中心，回忆偏差，主观疼痛和生活质量测量量表。结论：经中长期随访，ESWL治疗特发性CP患者大面积PD结石效果良好。
Background: Long-term results of extracorporeal shockwave lithotripsy (ESWL) for large pancreatic duct (PD) stones in patients with idiopathic calcific pancreatitis (CP) are scanty.Objective: To evaluate intermediate and long-term results of ESWL in a large cohort of patients with idiopathic CP.Design: Cross-sectional study; retrospective chart review.Setting: A high-volume, tertiary-care center for endoscopy and GI diseases.Patients: A total of 636 patients with idiopathic CP who underwent ESWL and ERCP were followed-up. Patients were divided into intermediate (24-60 months) and long-term (>60 months) follow-up groups.Intervention: ESWL and ERCP.Main Outcome Measurements: Improvement in pain, analgesic use, hospitalization for pain, recurrence of calculi, need for additional intervention, and quality of life.Results: A total of 636 of 1006 patients who underwent ESWL between 2004 and 2009 were followed for a maximum of 96 months. There were 364 patients in the intermediate follow-up group and 272 in the long-term follow-up group. After ESWL and ERCP, absence of pain was seen in 250 patients (68.7%), mild-to-moderate pain in 94 patients (25.4%), and severe pain in 20 patients (5.5%) of the intermediate group. In the long-term group, 164 patients (60.3%) had no pain, 97 patients (35.7%) had mild or moderate episodes of pain, whereas 11 patients (4.04%) had episodic severe pain. Recurrence of calculi was seen in 51 patients (14.01%) in the intermediate follow-up group and in 62 patients (22.8%) in the long-term group. Quality of life improved in a significant number of patients in both groups.Limitations: Retrospective study, single center, recall bias, and subjective pain and quality-of-life measurement scale.Conclusion: ESWL for large PD calculi offers good results in patients of idiopathic CP on intermediate and long-term follow-up.