膵石の治療戦略

Pancreatic stones： Therapeutic strategy based on the guidelines

要旨

　慢性膵炎に合併する膵石症は，慢性的な炎症をきたし，膵管が閉塞することで膵管内圧の上昇を引き起こし，疼痛や慢性的な炎症の原因となるためその対応は重要である。膵石は蛋白栓と石灰化結石に分類され，特に疼痛や膵炎の原因となる膵石が治療対象となる。治療の第一選択は内科的治療であり膵石破砕と内視鏡的膵石除去が行われる。破砕は体外衝撃波結石破砕術（extracorporeal shock wave lithotripsy：ESWL）が保険収載の手技として広く行われており，近年は膵管鏡下結石破砕術も行われている。また難治性・治療抵抗性の病態に対しては外科的治療が考慮され，膵管減圧術あるいは膵切除術が適応となる。個別の病態に対し段階的に適切な選択をしていく。

　Pancreatic lithiasis associated with chronic pancreatitis leads to persistent inflammation and pancreatic duct obstruction, resulting in elevated intraductal pressure, which causes pain and chronic inflammation. Therefore, appropriate management is crucial. Pancreatic stones are classified into protein plugs and calcified stones, with those causing pain or pancreatitis being the primary targets for treatment. The first-line approach is internal therapy, consisting of stone fragmentation and endoscopic stone removal. Extracorporeal shock wave lithotripsy (ESWL) is a widely used, and in recent years, intraductal lithotripsy using a pancreatoscope has also been introduced. In refractory or treatment-resistant cases, surgical interventions such as pancreatic duct drainage procedures or pancreatic resection may be considered. A stepwise and individualized treatment strategy should be employed based on the specific clinical context.