Management of Pancreatic Calculi: An Update.
Management of Pancreatic Calculi: An Update.
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DOI：
10.5009/gnl15555
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发表时间：
2016-11-15
期刊：
影响因子：
3.4
通讯作者：
Reddy DN
中科院分区：
文献类型：
--
作者：
Tandan M;Talukdar R;Reddy DN
胰石症或胰结石（PC）是慢性胰腺炎（CP）的后遗症，可发生在主管、侧支或实质。无论CP的病因如何，最终的结果都是结石。CP包含一个被连续的碳酸钙层包围的内病灶。这些结石阻塞胰管，造成胰管高压，导致疼痛，这是CP的主要特征。内镜治疗和手术都旨在清除这些结石，降低胰管高压。在小PC中，内镜逆行胆管造影（ERCP）后括约肌切开术和拔除术是治疗的选择。大结石需要体外冲击波碎石碎裂（ESWL）之前，他们的取出或自发排出。在适当选择的情况下，ESWL和ERCP是大型PC管理的护理标准。ESWL后的长期结果显示，大约60%的患者疼痛得到了很好的缓解。然而，ESWL有其局限性。经口胰镜检查和导管内碎石术代表了不断发展的技术，在目前的实践中，它们的使用仅限于具有相当专业知识的中心。所有广泛的PC，相关的多导管狭窄或内镜治疗失败的患者都应进行手术治疗。
Pancreatolithiasis, or pancreatic calculi (PC), is a sequel of chronic pancreatitis (CP) and may occur in the main ducts, side branches or parenchyma. Calculi are the end result, irrespective of the etiology of CP. PC contains an inner nidus surrounded by successive layers of calcium carbonate. These calculi obstruct the pancreatic ducts and produce ductal hypertension, which leads to pain, the cardinal feature of CP. Both endoscopic therapy and surgery aim to clear these calculi and decrease ductal hypertension. In small PC, endoscopic retrograde cholangiopancreatography (ERCP) followed by sphincterotomy and extraction is the treatment of choice. Large calculi require fragmentation by extracorporeal shock wave lithotripsy (ESWL) prior to their extraction or spontaneous expulsion. In properly selected cases, ESWL followed by ERCP is the standard of care for the management of large PC. Long-term outcomes following ESWL have demonstrated good pain relief in approximately 60% of patients. However, ESWL has limitations. Per oral pancreatoscopy and intraductal lithotripsy represent techniques in evolution, and in current practice their use is limited to centers with considerable expertise. Surgery should be offered to all patients with extensive PC, associated multiple ductal strictures or following failed endotherapy.
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