超声内镜引导下无水乙醇灌洗术治疗胰腺浆液性囊性肿瘤疗效观察

Clinical outcome of endoscopic ultrasound?guided ethanol lavage(EUS?EL) sessions for ablation of serous cystic neoplasms

目的 探究超声内镜引导下无水乙醇灌洗术（EUS-EL）治疗胰腺浆液性囊性肿瘤的临床疗效及安全性。方法回顾性分析第二军医大学长海医院消化内科2012年5月至2014年11月期间收治的13例胰腺浆液性囊性肿瘤患者的临床资料,其中6例接受超声内镜引导下无水乙醇灌洗术治疗及术后随访,另7例仅接受超声内镜引导下囊液抽吸术,进行为期7~36个月的随访。对两组患者临床症状、病灶大小的变化及复发率进行了比较,统计手术相关并发症的情况。结果 EUS-EL治疗组在治疗前后囊肿最大直径分别为（24.8±14.2）mm及（9.0±4.8）mm（P=0.004）。对照组在治疗前后囊肿最大直径分别为（21.3±11.6）mm及（18.6±14.0）mm（P=0.203）。EUS-EL治疗组和对照组的囊肿最大直径的变化分别为-15.8±3.1mm和-2.7±1.9mm（P=0.003）。EUS-EL治疗组无相关并发症发生,也无复发病例。治疗组囊肿完全消除4例,对照组完全消除1例。治疗组5例患者腹痛症状缓解,腹痛缓解1例（P=0.11）。结论 接受EUS-EL治疗胰腺浆液性囊性肿瘤可有效缓解临床症状、减小病灶大小,并发症少,安全性较高。

Objective To introduce a novel clinical treatment of endoscopic ultrasound-guided ethanol lavage （EUS-EL） sessions for ablation of serous cystic neoplasms（SCN） and evaluate its safety and effectiveness. Methods Retrospective review was performed in 13 patients who had been diagnosed with SCN by endoscopic ultrasound-guided fine needle aspiration （EUS-FNA） between May 2012 and November 2014 in Changhai Hospital, China. Six patients who accepted EUS-EL were divided into EUS-EL group and the other seven who merely received EUS-FNA were classified as control group. Final analysis was performed after 7-36 months of follow- up. Results The mean maximum cyst diameter of EUS-EL group before and after treatments were （24.8±5.8）mm and （9.0±4.8）mm （P= 0.004）, while the mean maximum cyst diameter of control group before and after treatments were （21.3±11.6）mm and （18.6±14.0） mm （P=0.203）, and the variation of mean maximum cyst diameter of EUS-EL group and control group was （-15.8±3.1）mm, （-2.7±1.9） mm （P= 0.003）, respectively. The procedure related complications and recurrence rate of EUS-EL group was 0 （0/6）. The complete cyst resolution rate of both groups was 66.7% and 14.3% （P=0.086）. Abdominal pain was improved in 5 members of EUS-EL group （5/5,100.0%） and only 1of 3 patients in control group got pain improved （33.3%）. Conclusion Our preliminary experience with EUS-EL shows a potential role for ablation in treating SCN in China, as a safe and efficient approach to treat selected patients, with high rates of complete resolution and pain release, and low rates of complication and recurrence.