胰管内外引流治疗胰腺假性囊肿疗效分析

Efficacy and clinical application value of endoscopic transpapillary drainage on pancreatic pseudocysts

目的分析内镜下经十二指肠乳头胰管内外引流治疗胰腺假性囊肿的临床疗效。方法对该院消化内镜中心治疗的胰腺假性囊肿病例进行回顾性分析,总结内镜治疗效果,评估该治疗方法的临床疗效。结果经内镜逆行胰胆管造影(ERCP)证实为交通性胰腺假性囊肿并接受内镜治疗的病例31例。经乳头括约肌切开(EST)和胰管括约肌切开(EPS)术后,初次引流全部成功。其中鼻胰管引流(ENPD)8例;胰管支架(ERPD)10例;ENPD+ERPD13例。术后出现囊肿感染4例,感染率13%(4/31)。经更换支架或反复冲洗,并加强抗感染治疗,治愈;2例转外科手术治疗,其中1例因胰腺假性囊肿多分隔,内镜下引流效果不佳,反复出现感染症状而转外科手术治疗,另外1例胰腺假性囊肿患者因引流液中查到异型细胞,考虑胰腺癌不排除而转手术切除,病理结果为胰腺癌;囊肿复发1例,再次给予ERPD引流后治愈;胰腺假性囊肿残腔形成1例。无出血、穿孔、死亡等并发症发生。胰管支架放置至囊肿消失时间平均3个月,平均住院40.6d。结论内镜经乳头引流治疗交通性胰腺假性囊肿是一种确切有效的治疗方法,合理应用,控制和预防感染是治疗的关键,应该得到重视。

[Objective] To evaluate the efficacy and clinical application value of endoscopic transpapillary drainage on pancreatic pseudocysts. [Methods] The data of endoscopic transpapillary drainage of pancreatic pseudocysts in 31 patients, who were treated in the Endoscopic Center of the Affiliated Hospital of Inner Mongolia Medical College, were retrospectively studied. [ Results] In 31 patient, pancreatic pseudocyst （PP） were proved to be communicated with the main pancreatic duct by endoscopic retrograde cholangiopancreatic drainage （ERCP）. After endoscopic transpapillary sphincterotomy and endoscopic pancreatic sphincterotomy, all the PPs were drained successfully at the first time. Among them, endoscopic naso-pancreatic duct drainage （ENPD） was done in 8 patients, endoscopic retrograde pancreatic drainage （ERPD） by inserting a double pigtail stent into the pseudocyst in 10 patients, and combination of ENPD and ERPD were used in 13 patients. Pseudocyst infections due to stents or drainage catheter clogging appeared in 4 of 31 patients （12.9%）. By replacing stents, aggressive irrigation via drainage catheters, pseudocyst infections were controlled and cured. During the drainage period, antibiotics and antifungal agents were administered. Two patients required surgical treatment because of multicyst persistent infectious process in 1 and pancreatic cancer in the other. Cyst recurred in 1 of the 31 patients （3.2%）, which was treated by a second ERPD, and cured. Pseudocyst residual cavity formed in 1 patient. There were no procedurerelated hemorrhage, perforation or deaths. The average drainage interval was 3 months （0.5-6 months）. The average hospitalization time was 40.6 days. [Conclusions] Endoscopic transpapillary drainage of PPs is a technically feasible, effective and safe treatment for PPs communicated with the pancreatic duct. Reasonable application and control and prevention of infection are crucial for the treatment. Much attention should be paid to this therapy.