中华胰腺病杂志
中華胰腺病雜誌
중화이선병잡지
CHINESE JOURNAL OF PANCREATOLOGY
2012年
1期
3-5
,共3页
胡良皞%廖专%叶博%郝峻烽%王伟%吴仁培%孙畅%蒋斐%辛磊%蒋丽丽%孙笑天%祁可%李兆申
鬍良皞%廖專%葉博%郝峻烽%王偉%吳仁培%孫暢%蔣斐%辛磊%蔣麗麗%孫笑天%祁可%李兆申
호량호%료전%협박%학준봉%왕위%오인배%손창%장비%신뢰%장려려%손소천%기가%리조신
体外震波碎石术%慢性胰腺炎%胰胆管造影术,内窥镜逆行%并发症
體外震波碎石術%慢性胰腺炎%胰膽管造影術,內窺鏡逆行%併髮癥
체외진파쇄석술%만성이선염%이담관조영술,내규경역행%병발증
Extracorporeal shock wave lithotripsy%Chronic pancreatitis%Cholangiopancreatography,endoscopic retrograde%Complications
目的 探讨体外震波碎石术(ESWL)治疗慢性胰腺炎(CP)胰管结石的适应证、治疗流程、麻醉方式、安全性和有效性.方法 观察2011年3月至7月长海医院消化内科诊治的CP患者(伴有结石直径＞0.5 cm).ESWL采用第三代体外震波碎石系统,通过X线定位结石,每个震波疗程不超过5000次冲击波,连续每日一次震波治疗,直至结石粉碎,再行ERCP取石.结果 5个月共治疗100例患者,84例曾行ERCP治疗,其中造影及深插管失败41例.多发结石83例,阳性结石占95％,阴性结石占2％,混合性结石占3％.完成ESWL治疗175例次,其中43％患者行2次以上ESWL.麻醉方式以静脉镇静为主(96％).ESWL治疗后行ERCP取石,插管成功96例,其中既往ERCP失败的41例中,ESWL治疗后成功插管37例.碎石成功率达100％.ESWL联合ERCP的结石完全清除率达78％,并发症发生率为2.28％,均为轻症.结论 ESWL安全有效,是CP微创治疗体系中不可或缺的技术之一.
目的 探討體外震波碎石術(ESWL)治療慢性胰腺炎(CP)胰管結石的適應證、治療流程、痳醉方式、安全性和有效性.方法 觀察2011年3月至7月長海醫院消化內科診治的CP患者(伴有結石直徑＞0.5 cm).ESWL採用第三代體外震波碎石繫統,通過X線定位結石,每箇震波療程不超過5000次遲擊波,連續每日一次震波治療,直至結石粉碎,再行ERCP取石.結果 5箇月共治療100例患者,84例曾行ERCP治療,其中造影及深插管失敗41例.多髮結石83例,暘性結石佔95％,陰性結石佔2％,混閤性結石佔3％.完成ESWL治療175例次,其中43％患者行2次以上ESWL.痳醉方式以靜脈鎮靜為主(96％).ESWL治療後行ERCP取石,插管成功96例,其中既往ERCP失敗的41例中,ESWL治療後成功插管37例.碎石成功率達100％.ESWL聯閤ERCP的結石完全清除率達78％,併髮癥髮生率為2.28％,均為輕癥.結論 ESWL安全有效,是CP微創治療體繫中不可或缺的技術之一.
목적 탐토체외진파쇄석술(ESWL)치료만성이선염(CP)이관결석적괄응증、치료류정、마취방식、안전성화유효성.방법 관찰2011년3월지7월장해의원소화내과진치적CP환자(반유결석직경＞0.5 cm).ESWL채용제삼대체외진파쇄석계통,통과X선정위결석,매개진파료정불초과5000차충격파,련속매일일차진파치료,직지결석분쇄,재행ERCP취석.결과 5개월공치료100례환자,84례증행ERCP치료,기중조영급심삽관실패41례.다발결석83례,양성결석점95％,음성결석점2％,혼합성결석점3％.완성ESWL치료175례차,기중43％환자행2차이상ESWL.마취방식이정맥진정위주(96％).ESWL치료후행ERCP취석,삽관성공96례,기중기왕ERCP실패적41례중,ESWL치료후성공삽관37례.쇄석성공솔체100％.ESWL연합ERCP적결석완전청제솔체78％,병발증발생솔위2.28％,균위경증.결론 ESWL안전유효,시CP미창치료체계중불가혹결적기술지일.
Objective To probe the indication,treatment algorithm,anesthesia method,safety and efficacy of extracorporeal shockwave lithotripsy (ESWL) in combination with endoscopic retrograde cholangiopancreatography (ERCP) for pancreatic duct stones.Methods The patients with chronic pancreatitis and large pancreatic duct stones ( ＞ 5 mm diameter) and receiving ESWL and ERCP between March and July 2011 in Changhai Hospital were prospective studied.The third generation of extracorporeal shockwave lithotripsy was applied in ESWL,and the localization of stone was determined by X-ray.No more than 5000 shocks were given per session,and ESWL was performed continuously till the calculi were fragmented,and then was cleared by ERCP.Results A total of 100 patients underwent ESWL during the 5 months,among whom 84 patients received ERCP treatment and 41 cases failed to deep cannulation (41/84,48.8％ ).Multiple stones were seen in 83 patients.Ninety five patients had radio-opaque stones,two patients had radiolucent calculi,while three patients had both radio-opaque and radiolucent stones.Seventy five percent,14％ and 11％ stones were located in pancreatic head,pancreatic head and body,pancreatic body and tail,respectively.A total of 175 ESWL procedures were performed,43 patients needed 2 or more sessions for successful fragmentation.Anesthesia method was mainly intravenous sedation,accounting for 96％ (168/175).ERCP was successful in 96 patients after ESWL,only 4 patients failed after ESWL. Forty one cases which failed ERCP procedures before ESWL underwent ERCP,and 37 patients (90.2％) achieved successful cannulation.Successful fragmentation rate was 100％.Complete clearance was achieved in 78 patients,and complication rate of post-ERCP pancreatitis,fever was 1.71％ (n =3 ),0.57％ (n =1 ),and the overall complication rate was 2.28％.Conclusions ESWL is an effective,safe and necessary modality for fragmentation of large PD stones in the management of minimal invasive treatment of chronic pancreatitis.
