Extracorporeal shock wave lithotripsy is a safe and effective treatment for pancreatic stones coexisting with pancreatic pseudocysts
Extracorporeal shock wave lithotripsy is a safe and effective treatment for pancreatic stones coexisting with pancreatic pseudocysts
复制标题
体外冲击波碎石术是治疗胰腺结石合并胰腺假性囊肿安全有效的方法。
DOI：
10.1016/j.gie.2015.10.026
复制
发表时间：
2016-07-01
影响因子：
7.7
通讯作者：
Li, Zhao-Shen
中科院分区：
文献类型：
--
作者：
Li, Bai-Rong;Liao, Zhuan;Li, Zhao-Shen
背景和目的：我们旨在研究胰腺体外冲击波碎石术（P-ESWL）去除慢性胰腺炎（CP）中与胰腺假性囊肿（PPC）共存的大胰腺结石的结果。方法：这是一项在至少有 1 个结石（>= 5 mm）的 CP 患者中进行的前瞻性研究。患者被分为PPC组（结石与PPC共存）或对照组（单独结石）。患者最初接受连续的 P-ESWL 治疗，然后接受 ERCP。主要结局是P-ESWL不良事件，次要结局是结石清除、长期疼痛缓解、生活质量评分改善和PPC回归。结果：2011年3月至2013年10月期间，共有849名患者（PPC组59名，对照组790名）接受了P-ESWL。PPC组和对照组之间P-ESWL不良事件的发生率相似 （11.86% 与 12.41%，P = .940）。初次P-ESWL联合ERCP治疗后，PPC组患者结石完全、部分和未清除率分别为67.24%、20.69%和12.07%，与对照组差异无统计学意义（完全、部分和未清除率分别为83.17%、10.40%和11.39%；P = .106）。 59 名 PPC 患者中的 55 名 (93.22%) 接受了中位随访时间 21.9 个月（范围：12.0-45.1）。随访 3 个月和 1 年后，分别有 56.36% (31/55) 和 76.36% (42/55) 的患者 PPC 消失。此外，分别有 63.64% (35/55) 和 25.45% (14/55) 的患者实现了完全和部分疼痛缓解。生活质量 (P < .001)、身体健康 (P < .001) 和体重减轻 (P < .001) 评分均有所改善。 结论：在我们的多专科三级中心，对于共存胰腺结石和 PPC 的患者，初始 P-ESWL 继之以 ERCP 是安全的，并且对结石清除、主胰管引流和疼痛缓解有效。
Background and Aims: We aimed to investigate outcomes of pancreatic extracorporeal shock wave lithotripsy (P-ESWL) for the removal of large pancreatic stones coexisting with pancreatic pseudocysts (PPCs) in chronic pancreatitis (CP).Methods: This is a prospective study performed in CP patients with at least 1 stone (>= 5 mm). Patients were divided into the PPC group (stones coexisting with PPCs) or the control group (stones alone). Patients were initially subjected to successive P-ESWL treatments, followed by ERCP. Primary outcomes were P-ESWL adverse events, and secondary outcomes were stone clearance, long-term pain relief, improved quality-of-life scores, and PPC regression.Results: A total of 849 patients (59 in the PPC group and 790 in the control group) was subjected to P-ESWL between March 2011 and October 2013. Occurrences of P-ESWL adverse events were similar between the PPC group and the control group (11.86% vs 12.41%, P = .940). After the treatment of initial P-ESWL combined with ERCP, the complete, partial, and nonclearance of stones occurred in 67.24%, 20.69%, and 12.07%, respectively, of patients in PPC group, with no significant difference from the control group (complete, partial, and nonclearance: 83.17%, 10.40%, and 11.39%, respectively; P = .106). Fifty-five of 59 patients (93.22%) with PPCs were followed for a median period of 21.9 months (range, 12.0-45.1). PPCs disappeared in 56.36% (31/55) and 76.36% (42/55) of patients after 3 months and 1 year of follow-up visits, respectively. Moreover, complete and partial pain relief were achieved in 63.64% (35/55) and 25.45% (14/55) of patients, respectively. The scores for quality of life (P < .001), physical health (P < .001), and weight loss (P < .001) improved.Conclusions: In our multispecialty tertiary center, initial P-ESWL followed by ERCP was safe in patients with coexisting pancreatic stones and PPCs and effective for stone clearance, main pancreatic duct drainage, and pain relief.