内镜下胰管支架20例临床应用

Application of Endoscopic Pancreatic Duct Stent Insertion: A Report of 20 cases

目的探讨内镜下胰管支架置入术的临床应用效果。方法回顾性分析2004年6月-2006年9月在我院住院经内镜置入胰管支架20例临床资料,其中慢性胰腺炎12例,复发性胰腺炎3例,十二指肠乳头腺瘤电切治疗后2例,胰腺癌3例,均在内镜逆行性胰胆管造影（ERCP）术后行胰管括约肌小切口,并置入胰管塑料支架。结果20例共放置胰管支架23次,支架留置25-105 d,平均64.5 d。术后2例支架移位,无术后胰腺炎。20例随访6-12个月,其中17例为12个月。12例慢性胰腺炎3个月随访时,除1例因ERCP导致十二指肠穿孔接受手术修补外,9例腹痛腹部不适症状消失,2例腹痛较术前明显减轻,进食,体重增加2-5 kg,平均3.2 kg,〉3个月随访时腹痛缓解率为92%（11/12）。3例胰腺癌患者在置入胆管支架的同时放置胰管塑料支架,术后黄疸减轻（平均下降61.8%）,进食及体重增加。复发性胰腺炎在随访期间无胰腺炎发作。结论胰管支架置入术创伤小而且安全,同时可以预防术后胰腺炎的发生,但是胰管支架移位是一个需要注意的并发症。

Objective To investigate the clinical effects of endoscopic pancreatic duct stent insertion. Methods The clinical data of 20 cases of endoscopic pancreatic stent insertion, including 12 cases of chronic pancreatitis, 3 cases of recurrent pancreatitis, 2 cases of papilla adenoma after resection, 3 cases of pancreatic carcinoma, was retrospectively reviewed from June 2004 to September 2006. All the patients underwent endoscopic pancreatic sphincterotomy and pancreatic stent insertion after endoscopic retrograde cholangiopancreatography（ERCP）. Results All the 20 patients received 23 procedures of pancreatic stent insertion. Stent-preserving time was 25 -105 days （mean, 64.5 days）. 2 cases experienced stent migration and no postoperative pancreatitis occurred. 20 patients were followed up for 6 to 12 months, including 17 patients for 12 months. During a follow-up period of 3 months in the 12 cases of chronic pancreatitis, 1 case received repair because of duodenal perforation induced by ERCP, and the symptoms of abdominal pain or discomfort disappeared or were distinctively relieved in 9 and 2 cases, respectively, with weight gain 2 - 5 kg （ mean, 3.2 kg）. A follow-up period of more than 3 months showed that the remission rate of abdominal pain was 92% （ 11/12）. The jaundice was alleviated （with the average of decrease of 61,8 percent of total bilirubin in serum） and weight gained in the 3 cases of pancreatic carcinoma after the biliary and pancreatic duct plastic stents were inserted at the same time. Patients with recurrent pancreatitis had no relapse in the follow-up period. Conclusions The endoscopic pancreatic duct stent insertion is a safe and minimal invasive procedure, and can prevent postoperative pancreatitis, but the main complication of stent migration should be considered.