胰管支架置入在内镜下十二指肠乳头腺瘤切除术中的价值

Value of pancreatic stent placement for endoscopic resection of duodenal papilla adenoma

目的评估胰管支架置入在十二指肠乳头腺瘤切除术中的应用价值。方法回顾性分析南京鼓楼医院消化内镜中心2007年8月至2016年7月就诊的67例经活检病理证实为十二指肠乳头腺瘤，并实施内镜下十二指肠乳头切除术的患者，其中50例行胰管支架置入（胰管支架置入组），另外17例未行胰管支架置入设为对照组。收集2组患者的基本资料、疗效和并发症情况。结果胰管支架置入组与对照组性别（P=0．070）、年龄（P=0．151）和肿瘤大小（P=0．136）无统计学差异。胰管支架置入组的整块切除率为90．0％（45／50），对照组为88．2％（15／17）；胰管支架置入组的完全切除率为96．0％（48／50），对照组为94．1％（16／17）。2组整块切除率（P=1．000）和完全切除率（P=1．000）均无统计学差异。胰管支架置入组和对照组术后出血（P=0．428）、胰腺炎（P=0．982）、胆管炎（P=1．000）、穿孔（P=1．000）发生率无统计学差异，2组均未发生迟发胰管远端狭窄。结论内镜下十二指肠乳头切除术后并无必要常规置入胰管支架，可在特殊病例中选择性置入。

Objective To assess the application value of pancreatic stent placement for endoscopic resection of duodenal major papilla adenoma. Methods A total of 67 cases of duodenal major papilla adenoma that were confirmed by biopsy and underwent endoscopic papillectomy from August 2007 to July 2016 in endoscopy center of Drum Tower Hospital of Nanjing were analyzed retrospectively. There were 50 patients treated with pancreatic stent placement and 17 patients without as the control group. The general information, efficacy and complications of two groups were collected at the same time. Results There were no significant differences in gender（ P = 0. 070） , age （ P = 0. 151 ） or tumor size （ P = 0. 136） between pancreatic stent placement group and the control group. There were no statistical differences in en bloc resection rates [ 90.0% （45/50） VS 88.2% （ 15/17）, P = 0. 100] or complete resection rates [ 96. 0% （48/50） VS 94. 1%（16/17） ,P= 1. 000] between the two groups. And there were no significant differences in short-term complications of bleeding （ P = 0. 428 ）, pancreatitis （ P = 0. 982）, cholangitis （ P =1. 000 ）, perforation（P= 1. 000）or long-term complications of distal common pancreatic duct stricture between the two groups. Conclusion Pancreatic stent should not be routinely placed in endoscopic papillectomy, and should be considered for specific cases.