Risk factors for complications of pancreatic extracorporeal shock wave lithotripsy
Risk factors for complications of pancreatic extracorporeal shock wave lithotripsy
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DOI：
10.1055/s-0034-1377753
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发表时间：
2014-12-01
期刊：
影响因子：
9.3
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
背景和研究目的：体外冲击波碎石术被推荐作为慢性胰腺炎结石的治疗方法。本研究的目的是调查胰腺体外冲击波碎石术（P-ESWL）并发症的危险因素。患者和方法：前瞻性纳入2011年3月至2013年6月期间接受P-ESWL治疗的疼痛性慢性胰腺炎和胰腺结石（直径>5 mm）患者。P-ESWL后的不良事件根据严重程度分为并发症和一过性不良事件。P-ESWL的主要并发症包括ESWL后胰腺炎、出血、感染、脓肿和穿孔。在单因素分析的基础上进行多因素分析，以检测总体和中重度并发症的危险因素。所有手术的总体并发症发生率为6.7%。62例患者（9.8%）在首次ESWL手术后发生并发症。并发症的危险因素为胰腺分裂（OR 1.28）和诊断为慢性胰腺炎至P-ESWL的时间间隔（OR 1.28）。保护性因素为男性（OR 0.50）、糖尿病（OR 0.45）和肥胖（OR 0.43）。男性是中重度并发症的唯一预测因素，也是保护因素（OR 0.19）。对于第二次P-ESWL手术，22/409例患者（5.4%）发生并发症。第一次ESWL治疗后并发症和无症状高淀粉酶血症与第二次ESWL治疗后并发症的风险显著相关（P
Background and study aims: Extracorporeal shock wave lithotripsy is recommended as treatment for stones in chronic pancreatitis. The aim of this study was to investigate the risk factors for complications of pancreatic extracorporeal shock wave lithotripsy (P-ESWL).Patients and methods: Patients with painful chronic pancreatitis and pancreatic stones (>5 mm diameter) who were treated with P-ESWL between March 2011 and June 2013 were prospectively included. Adverse events after P-ESWL were classified as complications and transient adverse events, depending on severity. The major complications of P-ESWL included post-ESWL pancreatitis, bleeding, infection, steinstrasse, and perforation. Multivariate analyses based on univariate analysis were performed to detect risk factors of overall and moderate-to-severe complications.Results: A total of 634 patients underwent 1470 P-ESWL procedures. The overall complication rate was 6.7% of all procedures. Complications occurred in 62 patients (9.8%) after the first ESWL procedure. The risk factors for complications were pancreas divisum (odds ratio [OR] 1.28) and the interval between diagnosis of chronic pancreatitis and P-ESWL (OR 1.28). Protective factors were male sex (OR 0.50), diabetes (OR 0.45), and steatorrhea (OR 0.43). Male sex, the only identified predictor for moderate-to-severe complications, was a protective factor (OR 0.19). For the second P-ESWL procedure, complications occurred in 22/409 patients (5.4 %). Complication and asymptomatic hyperamylasemia after the first ESWL session were significantly associated with higher risk for complications after the second ESWL session (P