超声内镜下一步穿刺法引流治疗胰腺假性囊肿

EUS-guided one-step drainage of pancreatic pseudocysts: report of 3 cases

目的探讨彩色多普勒超声内镜在胰腺假性囊肿治疗中的作用。方法在纵轴超声内镜监测下以一步法细针穿刺囊肿抽吸或引入导丝、插入鼻囊肿塑料管引流,治疗3例胰腺假性囊肿。结果3例胃内均无囊肿压迹表现,囊肿大小6.0 cm×5.9 cm,6.5 cm×3.8 cm,8.5 cm×5.0cm,位于胰腺体部、尾部和体尾交界各1例。2例囊肿周围血流信号不明显,1例囊壁周围可见血流信号,3例囊肿壁与胃壁间无明显层次回声。抽吸或置入鼻囊肿引流管后,患者分别于2 d、2 d和3 d腹痛缓解,引流3 d后病灶缩小,14 d、30 d囊肿消失。1例穿刺后胃黏膜局部渗血,用去甲肾上腺素冲洗止血,未发生感染、穿孔等并发症。随访2个月、5个月和7个月无复发。结论初步观察表明,超声内镜引导下的一步穿刺法简单、实用,感染及出血风险较小。

Objective To evaluate the significance of color Doppler EUS in the pancreatic pseudo-cysts drainage. Methods EUS - guided cystoenterostomy was performed in 3 patients. A needle and drainage tube was inserted in a one - step procedure into the cyst through the accessory channel of echoendoscope under EUS. The nasal plastic drainage tube was released immediately after insertion. Results When gastric ulcer and bleeding or the bulge of stomach were not found endoscopically in all patients . The needle with its stylet inserted through the gastric wall into the cyst at the site with minimal distance between them . The mean size of the pseudocysts was approximately 8 cm located at pancreatic tail ,body or the junction of them. In 3 cases but one, the blood flow signal around the cyst was not found . No significant echo of laminated structure between gastric and cyst wall was found . After aspiration or installation of naso-cystic drainage catheter, abdominal pain remitted at 2 days, 2 days and 3 days; the sonography demonstrated that cyst size decreased began from 3rd day ,and the cyst obliterated at 14 and 30 days after drainage. The only complication was found in one patient with gastric mucosal ooze, which recovered after noradrenaline spray . Infection or perforation never occurred. No recurrence of pseudocysts observed at a mean follow - up period of 3. 6 months (range 2-7 months). Conclusions The EUS-guided drainage of pancreatic pseudocysts in one-step is a rather simple and practical procedure with minimal risk of hemorrhage and infection.