超声内镜引导下经胃引流治疗早期胰腺假性囊肿23例

Early treatment of large pancreatic pseudocyst by EUS-guided transgastric drainage

目的探讨超声内镜引导下经胃引流治疗早期胰腺假性囊肿的疗效。方法回顾性分析2003至2008年在超声内镜引导下早期经胃穿刺置管引流进行治疗的23例巨大胰腺假性囊肿患者的临床资料。结果假性囊肿位于胰头部3例，胰体部11例，胰尾部9例，囊肿平均直径11em（8—18cm），均为单发囊性，所有病例在超声内镜引导下经胃引流治疗胰腺假性囊肿，假性囊肿发现至穿刺手术间隔17—65d，平均31d。2例术后发生囊肿感染，1例改用外引流，另1例改用手术内引流治疗治愈；3例出现消化道出血，保守治疗后治愈。2—3个月后CT复查，6例患者假性囊肿完全消失，余15例患者囊肿明显缩小，所有患者腹胀、腹痛症状缓解。随访1年，无溃疡、出血、囊腔感染等并发症发生。结论超声引导下早期经胃穿刺置管弓l流治疗胰腺假性囊肿是安全、有效的。

Objective To investigate the safety and efficacy on early treatment of large pancreatic pseudocyst by endoscopic ultrasound （EUS）-guided transgastric drainage. Methods The clinical data of 23 cases of large pancreatic pseudocyst treated with EUS-guided transgastric drainage from 2003 to 2008 was retrospectively analyzed. Results All were of single pseudocyst. Pseudocyst was present in the head of the pancreas in 3 cases, in the body of the pancreas in 11 cases, in the tail of the pancreas in 9 cases. Mean diameter of pancreatic pseudocysts was ll cm （range 8 -18 cm）. The interval between the finding of pseudocysts and EUS-guided transgastric drainage ranged 17 -65 d, averaging 31 d. Two had postoperative infection of the pseudocyst, one received percutaneous external drainage and the other one received surgical internal drainage. Three bad postoperative gastrointestinal bleeding and were treated with antacid and hemostatie drugs. Patients were examined by CT two to three months later. Pancreatic pseudocysts disappeared completely in 6 cases and significantly shrank in the rest. The clinical symptoms of all patients, such as abdominal pain, abdominal bloating were significantly relieved. All patients were followed-up for 1 year, there was no pseudocyst recurrence, ulcer,bleeding or infection. Conclusions Early treatment of large pancreatic pseudocyst by EUS-guided transgastric drainage is safe and effective.