胰腺炎合并感染性假性囊肿经内镜十二指肠乳头引流的治疗(附18例报告)

Endoscopic transpapillary drainage of infected pancreatic pseudocyst complicating pancreatitis,a report of 18 cases

目的探讨胰腺炎合并感染性假性囊肿经内镜十二指肠乳头引流治疗的临床效果。方法回顾性分析2004年1月-2006年6月经内镜十二指肠乳头引流治疗的18例胰腺炎合并感染性胰腺假性囊肿患者的临床资料,均经内镜下逆行胰胆管造影(ERCP)及CT诊断。常规性应用乳头括约肌切开术(EST)、胰管括约肌切开术(EPS)、鼻胰腺假性囊肿引流术(ENPPD),选择性应用胰管取石、探条及球囊导管狭窄扩张等手段进行治疗。治疗后复查ERCP、CT并行鼻胰引流管造影。结果治疗过程中应用胰管取石术6例,胰管狭窄扩张9例,胰管内支架置放8例。18例患者术后临床症状均明显缓解,引流出大量脓性胰液。感染症状于治疗48h后明显缓解,1周内得到控制。治疗后假性囊肿消失16例,明显缩小2例,胰腺功能均明显恢复。结论内镜在感染性胰腺假性囊肿的治疗中具有重要的临床价值,经十二指肠乳头内镜引流术安全、创伤小、费用低、疗效显著,是临床治疗的重要方法。

Objective To evaluate the effectiveness of endoscopic transpapillary drainage in the treatment of infected pancreatic pseudocyst complicating pancreatitis.Methods The data of 18 cases of pancreatitis with infected pancreatic pseudocyst having undergone endoscopic transpapillary drainage from Jan.2004 to Jun.2006 were retrospectively analyzed.All patients were diagnosed and then checked postoperatively by endoscopic retrograde cholangiopancreatography（ERCP） and CT.All patients were treated by endoscopic sphincterectomy（EST）,endoscopic pancreatic sphincterectomy（EPS）,or endoscopic nose-pancreatic pseudocysts drainage（ENPPD）.Extraction of pancreatic duct stones and dilatation of pancreatic duct stricture were performed selectively.Results During the treatment,removal of pancreatic stones was performed in 6 cases.Pancreatic duct dilatation was performed in 9 cases with pancreatic duct narrowing,and 8 cases received pancreatic stents drainage.Postoperatively,clinical symptoms were evidently alleviated in 18 patients,and with a large amount of purulent pancreatic fluid drained.Symptom of infection,including abdominal pain and fever,were within 48 hours after drainage,and were controlled within 1 week.Pancreatic pseudocysts disappeared in 16 cases,and conspicuously shrank in 2 patients.Pancreatic function recovered gradually following endoscopic transpapillary nose-pancreatic pseudocyst drainage.Conclusions In the treatment of pancreatitis with infected pancreatic pseudocyst,endoscopic transpapillary nose-pancreatic pseudocysts drainage is a preferred method for its safety,less trauma,lower expenditure,convenient and conspicuous curative effect.