Selection of treatment regimens for pancreatic duct stones: A comparative analysis

Jinbin DONG; Weibing FANG; Yihai SHI

doi:10.3969/j.issn.1001-5256.2022.11.023

Volume 38 Issue 11

Nov. 2022

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Article Navigation > Journal of Clinical Hepatology > 2022 > 38(11): 2558-2564

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Selection of treatment regimens for pancreatic duct stones: A comparative analysis

DOI: 10.3969/j.issn.1001-5256.2022.11.023

1.
Department of Gastroenterology, Gongli Hospital Affiliated to Naval Medical University, Shanghai 200135, China
2.
Department of Medical Ultrasonics, Chizhou Second Hospital, Chizhou, Anhui 247100, China

Research funding:

Shanghai Pudong New Area Health and Family Planning Commission Key Subspecialty Program (PWZy2020-05);

Medical Discipline Construction Project of Pudong Health Commiittee of Shanghai (PWYgf2021-08)

More Information

Corresponding author: SHI Yihai, zhuanyongabc@yeah.net(ORCID: 0000-0001-8489-4811)
Received Date: 2022-04-11
Accepted Date: 2022-05-12
Published Date: 2022-11-20

Abstract

Abstract

Objective To investigate the clinical efficacy of endoscopic retrograde cholangiopancreatography (ERCP), laparoscopy, and laparotomy in the treatment of pancreatic duct stones (PDS) by collecting related clinical data, to summarize the experience in selecting treatment regimens for PDS, and to further explore feasible treatment regimens that could maximize and optimize the benefits of PDS patients. Methods A retrospective analysis was performed for the clinical data of 131 PDS patients who were treated in Gongli Hospital Affiliated to Naval Medical University from June 2014 to December 2018, and according to the surgical procedure, they were divided into ERCP group with 69 patients, laparoscopy group with 32 patients, and laparotomy group with 30 patients. Related indices were monitored before and after treatment, and surgical outcome was compared between the laparoscopy group and the laparotomy group. The independent samples t-test was used for comparison of normally distributed continuous data between two groups; a one-way analysis of variance was used for comparison between multiple groups, and the least significant difference t-test or the SNK-q test was used for further comparison between two groups. The Mann-Whitney U test was used for comparison of continuous data with skewed distribution between two groups, and the Kruskal-Wallis H test was used for comparison between multiple groups. An repeated measures analysis of variance and the Friedman test were used for comparison of related indices before and after surgery, and the chi-square test was used for comparison of categorical data between groups. Results Among the 131 PDS patients, there were 40 patients with type Ⅰ PDS, 76 with type Ⅱ PDS, and 15 with type Ⅲ PDS. There was no significant difference in the distribution of main surgical methods between the laparoscopy group and the laparotomy group (χ²=1.93, P > 0.05). There were significant differences between the laparoscopy group and the laparotomy group in the dynamic changes of white blood cell count, C-reactive protein, procalcitonin, and Homeostasis Model Assessment of Insulin Resistance after surgery (F=24.68, χ²=227.66, F=45.37, F=106.71, all P < 0.05). Compared with the laparotomy group, the laparoscopy group had significantly shorter time of operation, significantly lower intraoperative blood loss, significantly shorter time to first flatus after surgery, a significantly lower frequency of use of pain-relieving drugs, shorter time to extraction of abdominal drainage tube, lower incidence rates of short-term postoperative complications, and a significantly shorter length of postoperative hospital stay (t=-4.80, t=-9.43, Z=-6.78, t=-11.59, Z=-6.77, χ²=9.24, t=-3.60, all P < 0.05). The incidence rate of short-term postoperative complications was 24.64% in the ERCP group, 28.13% in the laparoscopy group, and 66.67% in the laparotomy group, with a significant difference between groups (χ²=17.12, P < 0.05), and the ERCP group and the laparoscopy group had a significantly lower incidence rate of short-term postoperative complications than the laparotomy group (χ²=15.78 and 9.24, P < 0.05 and P=0.02). The treatment response rate was 91.30% in the ERCP group, 93.75% in the laparoscopy group, and 73.33% in the laparotomy group, with a significant difference between the three groups (χ²=7.70, P=0.02), and the ERCP group and the laparoscopy group had a significantly better response rate than the laparotomy group (χ²=5.56 and 4.77, P=0.02 and 0.03). Conclusion ERCP is the preferred method for minimally invasive treatment of some patients with type Ⅰ/Ⅱ PDS and is safe and effective with few serious complications. Surgical operation is an important method for the treatment of complex PDS, but with complicated techniques and difficult operation. Compared with laparotomy, laparoscopy has the advantages of small trauma, few serious complications, and high abdominal pain remission rate and can significantly shorten the time of operation, reduce intraoperative blood loss, and shorten the length of postoperative hospital stay. Therefore, laparoscopy should be the preferred regimen for the treatment of complex PDS.
- Pancreatic Duct Stones,
- Cholangiopancreatography, Endoscopic Retrograde,
- Laparoscopy,
- Digestive System Surgical Procedures

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References(16)

References

[1]	XU ZR, WANG HZ, YANG ZQ, et al. Risk factors analysis of pancreatic ductal stones combined with malignant tumor beside stones[J]. Chin J Dig Surg, 2018, 17(12): 1204-1208. DOI: 10.3760/cma.j.issn.1673-9752.2018.12.011. 徐正荣, 王槐志, 杨智清, 等. 胰管结石合并周围恶性肿瘤的危险因素分析[J]. 中华消化外科杂志, 2018, 17(12): 1204-1208. DOI: 10.3760/cma.j.issn.1673-9752.2018.12.011.
[2]	DREWES AM, BOUWENSE SAW, CAMPBELL CM, et al. Guidelines for the understanding and management of pain in chronic pancreatitis[J]. Pancreatology, 2017, 17(5): 720-731. DOI: 10.1016/j.pan.2017.07.006.
[3]	HU LH, LI ZS. Pancreatic extracorporeal shock wave lithotripsy[J]. J Hepatobiliary Surg, 2016, 24(6): 401-403. DOI: 10.3969/j.issn.1006-4761.2016.06.001. 胡良皞, 李兆申. 胰腺体外震波碎石技术[J]. 肝胆外科杂志, 2016, 24(6): 401-403. DOI: 10.3969/j.issn.1006-4761.2016.06.001.
[4]	Special Committee on Chronic Pancreatitis, Pancreatic Disease Specialized Committee, Chinese Medical Doctor Association. Guideline for the diagnosis and treatment of chronic pancreatitis(2018, Guangzhou)[J]. J Clin Hepatol, 2019, 35(1): 45-51. DOI: 10.3969/j.issn.1001-5256.2019.01.008. 中国医师协会胰腺病专业委员会慢性胰腺炎专委会. 慢性胰腺炎诊治指南(2018, 广州)[J]. 临床肝胆病杂志, 2019, 35(1): 45-51. DOI: 10.3969/j.issn.1001-5256.2019.01.008.
[5]	BASSI C, MARCHEGIANI G, DERVENIS C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After[J]. Surgery, 2017, 161(3): 584-591. DOI: 10.1016/j.surg.2016.11.014.
[6]	WAN L, ZHAO Q, CHEN J, et al. Expert consensus on the application of pain evaluation questionnaires in China(2020)[J]. Chin J Painol, 2020, 16(3): 177-187. DOI: 10.3760/cma.j.cn101379-20190915-00075. 万丽, 赵晴, 陈军, 等. 疼痛评估量表应用的中国专家共识(2020版)[J]. 中华疼痛学杂志, 2020, 16(3): 177-187. DOI: 10.3760/cma.j.cn101379-20190915-00075.
[7]	CHEN MF, WU JS, TIAN BZ, et al. Classification and surgical management of pancreatic duct stones[J]. Chin J Dig Surg, 2010, 9(5): 348-349. DOI: 10.3760/cma.j.issn.1673-9752.2010.05.010. 陈梅福, 吴金术, 田秉障, 等. 胰管结石的分型和治疗[J]. 中华消化外科杂志, 2010, 9(5): 348-349. DOI: 10.3760/cma.j.issn.1673-9752.2010.05.010.
[8]	WANG LW, LI ZS, LI SD, et al. A multi-center survey on chronic pancreatitis in China[J]. Chin J Pancreatol, 2007, 7(1): 1-5. DOI: 10.3760/cma.j.issn.1674-1935.2007.01.001. 王洛伟, 李兆申, 李淑德, 等. 慢性胰腺炎全国多中心流行病学调查[J]. 胰腺病学, 2007, 7(1): 1-5. DOI: 10.3760/cma.j.issn.1674-1935.2007.01.001.
[9]	YOU YL, GONG JP. Diagnosis and treatment of pancreatic duct stone[J]. Int J Surg, 2021, 48(6): 405-410. DOI: 10.3760/cma.j.cn115396-20210607-00208. 游宇来, 龚建平. 胰管结石的诊疗现状[J]. 国际外科学杂志, 2021, 48(6): 405-410. DOI: 10.3760/cma.j.cn115396-20210607-00208.
[10]	ISSA Y, BRUNO MJ, BAKKER OJ, et al. Treatment options for chronic pancreatitis[J]. Nat Rev Gastroenterol Hepatol, 2014, 11(9): 556-564. DOI: 10.1038/nrgastro.2014.74.
[11]	AN DJ, AN L, ZHANG C, et al. Clinical analysis of 76 cases of chronic pancreatitis complicated with pancreatic duct stones. [J]. Chin J Pancreatol, 2018, 18(4): 267-270. DOI: 10.3760/cma.j.issn.1674-1935.2018.04.014. 安东均, 安琳, 张成, 等. 慢性胰腺炎胰管结石76例临床分析[J]. 中华胰腺病杂志, 2018, 18(4): 267-270. DOI: 10.3760/cma.j.issn.1674-1935.2018.04.014.
[12]	ERCP Group, Chinese Society of Digestive Endoscopology, Biliopancreatic Group, Chinese Association of Gastroenterologist and Hepatologis, National Clinical Research Centerfor Digestive Diseases. Chinese Guidelines for ERCP(2018)[J]. J Clin Hepatol, 2018, 34(12): 2537-2554. DOI: 10.3969/j.issn.1001-5256.2018.12.009. 中华医学会消化内镜学分会ERCP学组, 中国医师协会消化医师分会胆胰学组, 国家消化系统疾病临床医学研究中心. 中国经内镜逆行胰胆管造影术指南(2018版)[J]. 临床肝胆病杂志, 2018, 34(12): 2537-2554. DOI: 10.3969/j.issn.1001-5256.2018.12.009.
[13]	RÖSCH T, DANIEL S, SCHOLZ M, et al. Endoscopic treatment of chronic pancreatitis: a multicenter study of 1000 patients with long-term follow-up[J]. Endoscopy, 2002, 34(10): 765-771. DOI: 10.1055/s-2002-34256.
[14]	YIN ZY, LIU Q, LI XM, et al. Endoscopic retrograde cholangio-pancreatography for pancreatic duct stones[J/CD]. Chin J Hepat Surg(Electronic Edition), 2020, 9(5): 466-470. DOI: 10.3877/cma.j.issn.2095-3232.2020.05.016. 尹振宇, 刘乾, 李晓梅, 等. ERCP治疗胰管结石[J/CD]. 中华肝脏外科手术学电子杂志, 2020, 9(5): 466-470. DOI: 10.3877/cma.j.issn.2095-3232.2020.05.016.
[15]	HE X, YOU J, JIN X, et al. Rational selection of surgical treatment for pancreatic duct stones[J]. J Clin Surg, 2018, 26(7): 29-30. DOI: 10.3969/j.issn.1005-6483.2018.07.017. 何鑫, 游建, 金鑫, 等. 胰管结石外科治疗体会[J]. 临床外科杂志, 2018, 26(7): 29-30. DOI: 10.3969/j.issn.1005-6483.2018.07.017.
[16]	GU F, CHENG R, ZHANG ST. Use of ERCP combined with ESWL in the treatment of pancreatic duct stones[J]. Chin J Bases Clin Gen Surg, 2022, 29(2): 141-145. DOI: 10.7507/1007-9424.202201009. 谷丰, 程芮, 张澍田. ERCP联合ESWL在胰管结石治疗中的应用[J]. 中国普外基础与临床杂志, 2022, 29(2): 141-145. DOI: 10.7507/1007-9424.202201009.

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Selection of treatment regimens for pancreatic duct stones: A comparative analysis

DOI: 10.3969/j.issn.1001-5256.2022.11.023

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