Clinical outcomes in patients who undergo extracorporeal shock wave lithotripsy for chronic calcific pancreatitis
Clinical outcomes in patients who undergo extracorporeal shock wave lithotripsy for chronic calcific pancreatitis
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DOI：
10.1067/mge.2002.128105
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发表时间：
2002-10-01
影响因子：
7.7
通讯作者：
Gibbons, RP
中科院分区：
文献类型：
--
作者：
Kozarek, RA;Brandabur, JJ;Gibbons, RP
背景：关于体外冲击波碎石和ERCP取石是否与胰腺炎的慢性疼痛缓解或复发有关，目前还存在争议。回顾了我们使用这项技术的最新经验。方法：对1995~2000年间收治的40例慢性钙化性胰腺炎患者行体外冲击波碎石取石治疗。收集的数据包括患者的表现、碎石和ERCP的次数、并发症和结果，包括ESWL前和后的疼痛评分、每月摄入的羟考酮(5 Mg)当量药片、每年的住院时间和后续手术的需要。结果：35例患者需要一次体外冲击波碎石治疗，共86次ERCP，以实现主胰管结石的完全取出。轻微并发症发生率为20%。有一例胰腺脓毒症患者接受了抗生素治疗，并摘除了堵塞的胰腺假体。在平均2.4年(0.6年)的随访期中，80%的患者避免了手术，疼痛评分(6.9vs.2.9[1.1]；p=0.001)、每年因胰腺炎住院(3.9vs.0.9[0.9]；p=0.001)和每月服用羟考酮类麻醉性药物(125.3vs.81[80])显著减少；结论：在大多数慢性胰腺炎患者中，体外冲击波碎石碎石联合内窥镜下主胰管的清除可显著改善患者的临床预后。
Background: There is controversy as to whether extracorporeal shock wave lithotripsy fragmentation and ERCP retrieval of pancreatic stones are associated with relief of chronic pain or relapsing attacks of pancreatitis. Our most recent experience with this technology is reviewed. Methods: Forty patients with chronic calcific pancreatitis who required extracorporeal shock wave lithotripsy between 1995 and 2000 to facilitate pancreatic duct stone removal were retrospectively reviewed. Data collected included patient presentation, number of lithotripsy and ERCP sessions required, complications, and outcomes measures to include pre- and post-ESWL pain scale, monthly oxycodone (5 mg)-equivalent pills ingested, yearly hospitalizations, and need for subsequent surgery.Results: A single extracorporeal shock wave lithotripsy session was required for 35 patients who underwent a total of 86 ERCPs to achieve complete stone extraction from the main pancreatic duct. Minor complications occurred in 20%. There was one episode of pancreatic sepsis that was treated with antibiotics and removal of an occluded pancreatic prosthesis. At a mean [SD] follow-up of 2.4 (0.6) years, 80% of patients had avoided surgery and there was a statistically significant decrease in pain scores (6.9 [1.3] vs. 2.9 [1.1]; p = 0.001), yearly hospitalizations for pancreatitis (3.9 [1.9] vs. 0.9 [0.9]; p = 0.001), and oxycodone-equivalent narcotic medication ingested monthly (125 [83] vs. 81 [80]; p = 0.03).Conclusions: Extracorporeal shock wave lithotripsy fragmentation of pancreatic duct calculi in conjunction with endoscopic clearance of the main pancreatic duct is associated with significant improvement in clinical outcomes in most patients with chronic pancreatitis.