超声内镜引导下穿刺引流治疗胰腺假性囊肿

Endoscopic ultrasonography-guided transmural drainage of pancreatic pseudocysts

目的探讨超声内镜引导下经胃肠壁穿刺置管引流治疗胰腺假性囊肿的疗效及并发症。方法选择2004年8月至2011年3月胰腺假性囊肿患者28例,首先使用线阵型超声内镜扫查,明确病变部位后选择合适穿刺点,导丝沿穿刺针道进入囊肿,沿导丝放置双猪尾硅胶支架1～3支。术后定期随访,囊肿消失后拔除支架。结果本组28例患者,穿刺引流成功25例,成功率为89.3%,其中经胃19例,经十二指肠6例。发生并发症3例,支架移位、出血、感染各1例。随访8～34个月,19例假性囊肿完全消失,6例腹痛症状消失、囊肿明显缩小、但持续存在2年以上,所有患者均未见假性囊肿复发。结论超声内镜引导下经胃肠壁穿刺置管引流术是治疗胰腺假性囊肿的较好方法之一,其疗效确切,并发症少。

Objective To explore the effect and complication of endoscopic ultrasonography-guided transmural drainage of pancreatic pseudocysts, Methods Endoscopic drainage of pancreatic pseudocysts was performed in 28 patients from August 2004 to March 2011 by using interventional echoendoscopes with a single-step device suitable for ballooning, bougination, and silica gel-stent insertion. All the patients were followed up and we pulled out the stent when the pancreatic pseudocysts disappeared. Results A total of 25 patients were successed,the technical success rate of the drainage procedure was 89.3 % （ Transgastric approach, 19/25. Transduodenal approach, 6/25 ）. Complications occurred in 3 patient （ one case of bleeding,one case of stent aversion,and one case of peritonitis ）. The volume of the pseudocyst was disappeared completely in all of 19 patients, 6 patients shrinked and reduced the symptom but pancreatic pseudocysts remained for two years based on a follow-up period of 8 - 34 months, there was no recurrence case after the procedure. Conclusions EUS-guided transmural drainage can be used to treat pancreatic pseudocysts with acceptable feasibility, efficacy, and safety.