Pancreatic Stone Removal

Pancreatic stone removal mainly includes endoscopic pancreatic duct stone removal, extracorporeal shock wave lithotripsy, laser lithotripsy, hydroelectric lithotripsy and endoscopic pancreatic duct stent drainage. Treatment of diseases: pancreatic stone disease Indication 1. Non-incarcerated stones in the main pancreatic duct, the main pancreatic duct is not narrowed at the distal end. 2. Small pancreatic duct stones. 3. Pancreatic schizophrenia with small and medium stones. Preoperative preparation 1. Patient preparation: endoscopic pancreaticophageal sphincter incision. 2. Instrument preparation: (1) Endoscopy: commonly used fiber and electronic duodenoscope, biopsy channel is above 3.2cm. (2) Contrast catheter: including a tip-specific catheter for the nipple and various types of catheters. (3) Guide wire: 0.035 inch, 0.018 inch conventional guide wire and super-slip guide wire, the length is 400 cm. (4) pancreatic duct stent: including 5.0F and 7.0F pancreatic duct stents with various lengths of barbs. (5) Pushing catheter: including 5.0F, 7.0F, and 170cm length pushing catheter. (6) High frequency electric generator. (7) High-frequency electric knife: pull type and needle-shaped cutting knife. (8) Instruments for nasal pancreatic duct drainage: including nasal pancreatic drainage tube, 0.035 inch and 0.018 inch guide wire, nasal guide tube, drainage fluid reservoir, etc. (Note: 1 inch = 2.54 cm). (9) Stone basket and lithotripter: mechanical gravel that can be used for biliary and pancreatic ducts. (10) Take the stone balloon catheter. (11) Extracorporeal shock wave lithotripter. (12) Laser lithotripter: such as -, aluminum garnet laser generator SupErb; -, aluminum garnet laser generator Variopulse; -, aluminum garnet laser generator NEUROTEST; long pulse dye laser generation VASOGNOST; Lithognost with stone recognition. (13) Liquid electric lithotripter (ESWL). Surgical procedure 1. Stone removal by endoscope: This method is only used for pancreatic stones without pancreatic duct. If there is no pancreatic duct stenosis, the sphincter can be cut open and stone. When the stone is large, it can be removed by ultrasonic lithotripsy or laser shock wave. After the stone has been ultrasonically crushed, the stone is broken smaller and can be discharged by itself. If the pancreatic duct has a stenosis factor, although the stone is broken and taken out, and the obstruction factor is not relieved, stones will still form in the future. 2. Partial resection of the pancreas: refers to stones that are confined to the body of the pancreas and the tail of the pancreas and that the pancreas is more severely damaged. When the pancreatic body and the tail are resected, the proximal end of the pancreatic duct is not narrow, and the pancreatic juice is not affected, and the stump of the pancreas can be sutured. When there is a stenosis factor in the proximal end of the pancreatic duct, the vaginal canal of the pancreatic duct can be nested or end-to-side Roux-y anastomosis. Since most of the islet cells are in the tail and body of the pancreas, excessive removal of the pancreas and tail from a diseased pancreas will result in severe pancreatic endocrine function. Therefore, the pancreas and the tail should be retained more, and the pancreas-jejunum anastomosis can be performed when there is a stenosis at the proximal end. 3. Pancreatic duct stones combined with pancreatic cysts: on the one hand stone will be stone, on the other hand cyst and intestinal drainage. 4. Pancreatic parenchyma incision and stone removal: adapted to the head of the pancreas, body stones, and associated with multiple narrow pancreatic ducts. The proximal part of the head of the pancreas and the isolated solitary stone are not stenotic. The fibrotic pancreatic tissue is cut at the stone to remove the stone, and the cut pancreatic duct and the pancreas are properly sutured. However, cases of this condition are rare. In general, multiple stones in the pancreatic duct are accompanied by multiple stenosis and dilation. In order to relieve the obstruction, sometimes the pancreatic duct is mostly or nearly completely opened, the stone is removed, and the opened pancreatic duct is anastomosed to the side of the jejunum. Since most of the pancreas is fibrotic, there is not much bleeding when the pancreatic duct is opened. complication Pancreatic damage caused by pancreatic stones is more obvious, so it is easy to cause a series of complications, such as diabetes, pancreatic cancer and so on.