胰腺体外震波碎石治疗慢性胰腺炎合并主胰管结石的疗效、安全性分析以及碎石成功影响因素分析  

Effect and safety of pancreatic extracorporeal shock wave lithotripsy in chronic pancreatitis with pancreatic duct stone and analysis of influencing factors of the success of lithotripsy

作　　者：敖翔 白娅娅 祁可 冉桃菁 沈潇男 秦显政 张尧 张玲 周春华 邹多武 Ao Xiang;Bai Yaya;Qi Ke;Ran Taojing;Shen Xiaonan;Qin Xianzheng;Zhang Yao;Zhang Ling;Zhou Chunhua;Zou Duowu(Department of Gastroenterology,Digestive Endoscopy Center,Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院消化内科/消化内镜中心,上海200025

出　　处：《中华肝胆外科杂志》2025年第3期172-176,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：国家自然科学基金(82270667)。

摘　　要：目的分析胰腺体外震波碎石(P-ESWL)治疗慢性胰腺炎(CP)合并主胰管结石患者的有效性、安全性及碎石成功的影响因素。方法回顾性分析2022年1月至2023年12月就诊于上海交通大学医学院附属瑞金医院消化内科并行P-ESWL治疗的132例CP合并主胰管结石患者的临床资料,其中男性103例,女性29例,年龄(50.3±16.9)岁。分析P-ESWL碎石次数、碎石成功率、联合或未联合内镜逆行胰胆管造影(ERCP)取石、主胰管结石清除率、术后并发症(急性胰腺炎、腹腔血肿、感染、石街、穿孔等)。单因素和多因素logistic回归分析碎石成功的影响因素。结果132例患者均接受了P-ESWL,碎石次数为(2.23±0.82)次,碎石成功的有115例(87.1%,115/132),107例(81.1%,107/132)患者为首次碎石。132例患者中12例(9.1%,12/132)仅行P-ESWL,120例(90.9%,120/132)P-ESWL术后联合ERCP取石;结石有效清除95例(72.0%,95/132),结石完全清除62例(47.0%,62/132)。P-ESWL术后并发症包括急性胰腺炎8例(6.1%,8/132)、石街伴急性胰腺炎2例(1.5%,2/132)、腹腔血肿1例(0.8%,1/132),无感染及穿孔发生。多因素logistic回归分析,结石CT值越大(OR=1.239,95%CI:1.040~1.477,P=0.017)碎石成功的可能性越小。结论P-ESWL治疗CP合并主胰管结石安全可行,能够有效清除结石,结石CT值大是碎石成功的危险因素。Objective To investigate the effect and safety of pancreatic extracorporeal shock wave lithotripsy(P-ESWL)in treating the chronic pancreatitis(CP)patients with main pancreatic duct(MPD)stones and to analyze the influencing factors of success of lithotripsy.Methods Clinical data of 132 patients with CP complicated with MPD stones treated with P-ESWL in the Department of Gastroenterology,Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2022 to December 2023 were retrospectively analyzed,including 103 males and 29 females,aged(50.3±16.9)years.The times of P-ESWL,the success rate of stone fragmentation,the necessity of combining endoscopic retrograde cholangiopancreatograhy(ERCP),clearance rate of MPD stones,and incidence of post-P-ESWL complications(acute pancreatitis,abdominal hematoma,infection,steinstrasse,perforation,etc.)were evaluated.The factors influencing the success rate of lithotripsy were analyzed using univariate and multivariate logistic regression.Results All patients underwent P-ESWL treatment,with(2.23±0.82)times of P-ESWL per person.The success rate of stone fragmentation was 87.1%(115/132).Of 107 CP patients(81.1%,107/132)were treated with their first P-ESWL.Of 12 patients(9.1%,12/132)underwent single P-ESWL,and 120(90.9%,120/132)underwent P-ESWL combined with ERCP.There were 95 cases(72.0%,95/132)with effective removal of stones,and 62(47.0%,62/132)with complete removal of stones.Post-P-ESWL complications included eight cases(6.1%,8/132)of acute pancreatitis,two(7.6%,2/132)of steinstrasse complicated with acute pancreatitis and one(0.8%,1/132)of abdominal hematoma.No infection or perforation occurred.Multivariate logistic regression analysis showed that the higher CT value of stones(OR=1.239,95%CI:1.040-1.477,P=0.017)was associated with the lower success rate of stone fragmentation.Conclusion P-ESWL is safe and effective in treating patients with CP complicated with MPD stones.The CT value of stones is a risk factor for the success rate of P-ESWL.

关 键 词：胰腺炎 慢性 结石 石碎石术 治疗结果 

分 类 号：R576[医药卫生—消化系统] R657.5[医药卫生—内科学]