ABSTRACT
Objective:
To analyze the
therapeutic effect and
safety of pancreatic extracorporeal
shock wave lithotripsy(P-ESWL) for
patients with
chronic pancreatitis complicated by stones of the
pancreatic duct and to investigate the influencing factors.
Methods:
A retrospective
analysis was performed on clinical data from 81
patients with
chronic pancreatitis complicated by
pancreatic duct calculus treated with P-ESWL in the Department of Hepatobiliary
Surgery, the First Affiliated
Hospital of Xi 'an Jiaotong
University from July 2019 to May 2022. There were 55
males(67.9%) and 26
females(32.1%). The age was (47±15)years (range 17 to 77 years). The maximum diameter(M(IQR)) of the stone was 11.64(7.60) mm, and the CT value of the stone was 869 (571) HU. There were 32
patients (39.5%) with a single
pancreatic duct stone and 49
patients(60.5%) with multiple
pancreatic duct stones. The
effectiveness, remission rate of
abdominal pain, and
complications of P-ESWL were evaluated.
Student's t test,
Mann Whitney U test, χ2 test, or Fisher's exact test was used to compare the characteristics between the effective and ineffective groups of
lithotripsy. The factors influencing the effect of
lithotripsy were analyzed by univariate and multivariate
logistic regression analysis.
Results:
Eighty-one
patients with
chronic pancreatitis were treated with P-ESWL 144 times, with an average of 1.78 (95%CI1.60 to 1.96) times per
person. Among them, 38
patients(46.9%) were treated with
endoscopy. There were 64 cases(79.0%) with effective removal of
pancreatic duct calculi and 17 cases(21.0%) with ineffective removal. Of the 61
patients with
chronic pancreatitis accompanied by
abdominal pain, 52 cases(85.2%) had
pain relief after
lithotripsy. After
lithotripsy treatment, 45
patients(55.6%) developed
skin ecchymosis, 23
patients(28.4%) had sinus
bradycardia, 3
patients(3.7%) had
acute pancreatitis, 1
patient(1.2%) had a stone lesion, and 1
patient(1.2%) had a hepatic
hematoma. Univariate and multivariate
logistic regression analysis showed that the factors affecting the
efficacy of
lithotripsy included the age of
patient(OR=0.92, 95%CI 0.86 to 0.97), the maximum diameter of the stone(OR=1.12,95%CI1.02 to 1.24) and the CT value of the stone(OR=1.44, 95%CI 1.17 to 1.86).
Conclusions:
P-ESWL is effective in the
treatment of
patients with
chronic pancreatitis complicated by
calculi of the
main pancreatic duct.Factors affecting the
efficacy of
lithotripsy include
patient's age, maximum stone diameter, and CT value of
calculi.