胰周积液内镜下引流:一项116例患者的病因学、引流技术和效果比较

Background:Pancreatic-fluid collections are frequent sequelae of acute and chronic pancreatitis,and endoscopic drainage of these collections has gained acceptance as an alternative to surgical drainage.Methods:Patient data,collection characteristics,drainage technique,and outcomes were obtained through chart review and prospective follow-up for 116 patients with attempted endoscopic drainage of symptomatic pancreatic-fluid collections.Results:A total of 116 patients presented with fluid collections classified as acute fluid collection(n = 5),necrosis(n = 8),acute pseudocyst(n = 30),chronic pseudocyst(n = 64),and pancreatic abscess(n = 9).The median diameter of the collection drained was 60 mm(15-275 mm).Median follow-up after drainage was 21 months.The drainage technique was transpapillary in 15 patients,transmural in 60,and both in 41.Successful resolution of symptoms and collection occurred in 87.9%of cases.No difference in success rates was observed between patients with acute pancreatitis and those with chronic pancreatitis.However,drainage of organized necrosis was associated with a significantly higher failure rate than other collections.No significant differences were observed regarding success when disease,drainage technique,or site of drainage was considered.Complications occurred in 13 patients(11%),and there were 6 deaths in the 30 days after drainage,including one that was procedure related.Conclusions:Endoscopic drainage of pancreatic-fluid collections is successful in the majority of patients and is accompanied by an acceptable complication rate.

重型慢性胰腺炎支架植入后长期结果

Background and Study Aims: Although it has been proved that pancreatic stentin g is effective in the symptomatic management of severe chronic pancreatitis, lon g-term outcomes after stent removal have not been fully evaluated. Patients and Methods: A total of 100 patients (75 men, 25 women; median age 49) with severe chronic pancreatitis and pancreatic duct strictures were successfully treated fo r pancreatic pain using polyethylene pancreatic stents and were followed up for at least 1 year after stent removal. The stents were exchanged “on demand" (in cases of recurrence of pain) and a definitive stent removal was attempted on the basis of clinical and endoscopic findings. Clinical variables were retrospectiv ely assessed as potential predictors of re-stenting. Results: The etiology of t he chronic pancreatitis was alcoholic (77%), idiopathic (18%), or hereditary ( 5%). Patients were followed up for a median period of 69 months (range 14-163 months) after study entry, including a median period of 27 months (range 12 -12 6 months) after stent removal. The median duration of pancreatic stenting before stent removal was 23 months (range 2 -134 months). After attempted definitive stent removal, 30 patients (30%) required re-stenting within the first year of follow-up, at a median time of 5.5 months after stent removal (range 1-12 mon ths), while in 70 patients (70%) pain control remained adequate during that period. By the end of the follow-up period a total of 38 patients had require d re-stenting and four ultimately underwent pancreaticojejunostomy. Pancreas di visum was the only factor significantly associated with a higher risk of re-ste nting (P = 0.002). Conclusions: The majority (70%) of patients with severe chro nic pancreatitis who respond to pancreatic stenting maintain this response after definitive stent removal. However,a significantly higher re-stenting rate was observed in patients with chronic pancreatitis and pancreas divisum.

胰腺括约肌切开术后胰腺炎的患病风险:一项572例患者回顾

Background and study aims:Endoscopic pancreatic sphinc-terotomy is indispensable for many therapeutic endoscopic maneuvers,but is also associated with a higher risk of pancreatitis after endoscopic retrograde cholangiopancreatography(ERCP) .In this study,this subgroup of patients was investigated in order to identify risk factors and protective factors.Patients and methods:A retrospective chart review identified 572 endoscopic pancreatic sphincterotomies that met the inclusion criteria.Charts were examined for indications,endoscopic technique,and outcomes,including pancreatitis.Results:A total of 477 patients underwent 572 endoscopic pancreatic sphincterotomies during a 5-year period.Indications for sphincterotomy included chronic pancreatitis(n = 398) ,access for tissue sampling(n = 52) ,acute recurrent pancreatitis(n = 45) ,transpapillary drainage of a pancreatic pseudocyst(n = 32) ,precut access to the common bile duct(n = 29) ,and others(n = 16) .Pancreatic duct drainage was performed in 69.1% of the procedures(nasopancreatic catheter,n = 290,or pancreatic stent placement,n = 105) .Post-ERCP pancreatitis occurred in 69 cases(12.1%) and was severe in 10.The multivariate analysis identified female sex as being associated with a higher risk of pancreatitis,while an elevated C-reactive protein level,pancreatic ductal stones,sphincterotomy at only the major papilla,and pancreatic duct drainage with a nasopancreatic catheter or stent were associated with a lower risk.Conclusions:This large series of patients undergoing endoscopic pancreatic sphincterotomy provides further evidence that both patient characteristics and technical factors modify the risk profile for post-ERCP pancreatitis.In addition to providing further definition of which patients are at risk,it also suggests that pancreatic duct drainage is an independently significant protective maneuver.