内镜下诊治伴发胰管结石慢性胰腺炎的价值

目的探讨ERCP在胰管结石诊断和治疗中的临床价值及其安全性评估。方法分析2008年2月～2008年10月期间共20例接受ERCP诊断和治疗的伴发胰腺结石慢性胰腺炎患者的临床资料。结果20例病例中，16例（80％）胰管结石位于胰头处，3例（15％）位于胰头及胰体处，1例（5％）累及全程胰管。14例（70％）患者一次性取石完全，5例患者术后接受体外震波碎石（ESWL），1例患者未能完成取石，建议其外科手术治疗．18例表现为腹痛的病例，在接受内镜下治疗结石后，腹痛症状均消失，在接受治疗后2～10d内出院，平均（5．3±2．43）d。术后2例（10％）出现一过性的血淀粉酶升高。结论对于伴有胰管结石的慢性胰腺炎病例而青，内镜下取石是安全有效的方法，同时应川支架及鼻胰管引流，不仅对胰管结石的治疗有效，而且充分的胰液引流对于缓解腹痛症状、减少术后的胰腺炎、高淀粉酶m症的发乍有着重要的作用。

The value of endoscopic treatment of pancreatic stones in patients with chronic pancreatitis

Objective To evaluate the value and safety of endoscopic pancreatic stone removal in patients with chronic pancreatitis. Methods Analysis of 20 cases of pancreatic stones in patients with chronic panereatitis underwent the endoscopic pancreatic stone removal from February to October in 2008. Results The stones of 16 cases were located within the head of the pancreas （80%） , 3 cases had stones within the body and head of pancreas （15%） , and 1 case had stone within the pancreas （5%）. Stones were completely removed in 14 patients （70%）. In 5 patients, extraeorporeal shock-wave lithotomy （ESWL） was followed after first endoscopic retrograde eholangiopancreatography （ERCP）. In the remaining 1 patient, endoscopic treatment was unsuccessful and surgical intervention became necessary. The 18 of 20 patients presenting with abdominal pain became completely pain-flee and discharged in 2 - 10 days （5.3 ± 2.43 days） after completion of the therapeutic measures. No severe complications occurred. Serum amylase was mild in- creased in 2 patients. Conclusion Endoscopic pancreatic stone removal in patients with chronic pancreatitis is an efficient and safe method. Endoscopic naso pancreatic drainage （ENPD） and endoscopic retrograde pancreatic drainage （ERPD） can not only relieve the symptom of abdominal pain by decompression of duetal hypertension, but also reduce the risk of post-ERCP complications, such as pancreatitis, hyperamylasemia.