内镜腔内引流术治疗急性胰腺炎合并胰腺包裹性坏死或假性囊肿的长期疗效分析

Long-term efficacy of endoscopic transluminal drainage for acute pancreatitis complicated with walled-off necrosis or pancreatic pseudocyst

目的评价急性胰腺炎合并包裹性坏死(walled-off necrosis, WON)或胰腺假性囊肿(pancreatic pseudocyst, PPC)行内镜腔内引流术(endoscopic transluminal drainage, ETD)的长期疗效。方法纳入2014年1月-2020年2月在南京鼓楼医院通过腹部CT和(或)超声确诊为WON或PPC并行ETD治疗的患者共79例。通过回顾患者病历资料, 对患者进行电话随访来评估胰腺内外分泌功能和长期生存质量等长期疗效指标。结果共纳入50例患者, 分为伴感染的WON/PPC组(n=31)和无感染的WON/PPC组(n=19)。伴感染的WON/PPC组17例(54.84%)患者和无感染的WON/PPC组11例(57.89%)患者体重减轻5%及以上, 2组体重减轻5%及以上的占比差异无统计学意义(P=0.833), 且两组减轻体重差异无统计学意义[(12.59±8.89)kg 比(10.91±2.47)kg, P=0.522]。伴感染的WON/PPC组有1例发生慢性腹痛, 2组Izbicki评分差异无统计学意义(23.79±6.74 比 22.03±3.21, P=0.295)。2组均无脂肪泻发生。伴感染的WON/PPC组和无感染的WON/PPC组内分泌功能不全发生率分别为16.67%(5/30)和 40.00%(6/15), 2组差异无统计学意义(P=0.140)。患者低密度脂蛋白胆固醇(HR=1.9, 95%CI:1.0~3.4, P=0.044)和甘油三酯(HR=1.2, 95%CI:1.0~1.3, P=0.029)越高, 发生继发性糖尿病的风险越大。结论 ETD治疗WON和PPC安全且有效, 但可能发生继发性糖尿病, 患者低密度脂蛋白胆固醇和甘油三酯水平越高, 发生继发性糖尿病的风险越大。

Objective To evaluate the long-term efficacy of endoscopic transluminal drainage(ETD)for acute pancreatitis complicated with walled-off necrosis(WON)or pancreatic pseudocyst(PPC).Methods A total of 79 patients who were diagnosed as having WON or PPC by abdominal CT or ultrasound and treated with ETD in Nanjing Drum Tower Hospital were enrolled.Past medical records and follow-up by phone call after discharge were analyzed for long-term outcomes including endocrine and exocrine functions and long-term quality of life.Results A total of 50 patients were enrolled,including 31 patients with infected WON/PPC and 19 patients with uninfected WON/PPC.Seventeen patients(54.84%)in the infected WON/PPC group and 11 patients(57.89%)in the uninfected WON/PPC group lost 5%or more of their weight.There were no significant differences in the proportion of cases of weight loss of 5%or more(P=0.833),or the weight loss between the two groups(12.59±8.89 kg VS 10.91±2.47 kg,P=0.522).Only one patient in the infected WON/PPC group had chronic abdominal pain.There was no significant difference in the Izbicki score between the two groups(23.79±6.74 VS 22.03±3.21,P=0.295).None of the patients developed steatorrhea after discharge.Five patients(16.67%,5/30)in the infected WON/PPC group and 6 patients(40.00%,6/15)in the uninfected WON/PPC group developed endocrine insufficiency with no significant difference(^O.140).Greater risk of secondary diabetes resulted from higher low-density lipoprotein cholesterol(HR=1.9,95%CI:1.0-3.4,P=0.044)and triglycerides(HR=1.2,95%CI:1.0-1.3,P=0.029).Conclusion ETD is safe and effective for WON and PPC.But there is possibility that patients develop secondary diabetes.Additionally,greater risk of secondary diabetes results from higher low-density lipoprotein cholesterol and triglycerides.