摘要
目的评估腔壁贴合型全覆膜自膨式金属支架（LAMS）在治疗胰周液体积聚（PFC）中的应用价值。方法纳入2015年7月至2017年7月在南京大学医学院附属鼓楼医院消化内镜中心应用LAMS行超声内镜引导下穿刺引流治疗PFC的患者。纳入标准为首次接受治疗；年龄≥18周岁；PFC直径〉6 cm且有压迫现象等临床表现，或持续观察见直径增大，或出现感染征象；病程〉4周，且囊肿壁和消化管壁间距离≤1 cm；排除其他胰腺囊性病变，如浆液性囊腺瘤（癌）、黏液性囊腺瘤（癌）、实性假乳头状瘤等。回顾性分析所有纳入患者的临床资料，并总结其疗效及术后并发症发生情况。结果共纳入27例PFC患者，均成功穿刺并置入LAMS，PFC完全引流率为96.3%（26/27）。LAMS维持时间的中位数为26 d，范围为4～135 d。17例患者通过LAMS行清创治疗，清创次数为（2.5±1.3）次。2例患者行内镜下逆行胰胆管造影术并放置胰管支架，5例行体外经皮穿刺引流，1例行外科手术引流。27例PFC患者中，发生并发症8例（29.6%），包括支架移位2例，术后感染3例，穿孔2例，出血1例，均在保守治疗后好转；无患者死亡。结论LAMS在PFC的治疗中有效且相对安全，可能会改变PFC的临床治疗策略。
ObjectiveTo assess the application value of lumen-apposing, fully covered, self-expandable metal stent （LAMS） in the treatment of peripancreatic fluid collection （PFC）.MethodsFrom July 2015 to July 2017, at Drum Tower Hospital Affiliated to Medical School of Nanjing University, the patients with PFC who received LAMS under endoscopic ultrasound were enrolled. The inclusion criteria was the first treatment, age ≥18 years old, PFC diameter 〉6 cm and clinical manifestations of compression, or increased diameter of PFC after continuous observation, or signs of infection, course 〉four weeks, and the distance between the cyst wall and the digestive gastrointestinal wall less than 1 cm; exclude other pancreatic cystic lesions, such as serous cystic neoplasm, mucinous cystic neoplasm and solid pseudopapillary neoplasm. The clinical data of enrolled patients were retrospectively analyzed, and the efficacy and postoperative complication were summarized.ResultsA total of 27 patients with PFC were enrolled. All patients were successfully punctured and placed with LAMS. The percentage of complete drainage rate of PFC was 96.3% （26/27）. The median LAMS maintenance time was 26 days, with a range of four to 135 days. Seventeen patients received debridement treatment through LAMS, and the number of debridement treatment was （2.5±1.3） times. Two patients underwent endoscopic retrograde cholangiopancreatography （ERCP） and were placed with pancreatic stent, five patients received percutaneous drainage, and one patient underwent surgical drainage. Among 27 patients with PFC, eight patients （29.6%） coexisted with complications, including stent displacement in two cases, postoperative infection in three cases, perforation in two cases and bleeding in one case. They all improved after conservative treatment and none of them died.ConclusionLAMS is effective and relatively safe in the treatment of PFC, and may change the clinical treatment strategy of PFC.
作者
沈永华
朱浩
邹晓平
吕瑛
王雷
刘明东
Shen Yonghua;Zhu Hao;Zou Xiaoping;Lyu Ying;Wang Lei;Liu Mingdong(Department of Gastroenterology,Drum Tower Hospital Affiliated to Medical School of Nanjing University,Nanjing 210008,China)
出处
《中华消化杂志》
CAS
CSCD
北大核心
2018年第10期678-681,共4页
Chinese Journal of Digestion
关键词
胰腺假囊肿
包裹性坏死
金属支架
胰周液体积聚
Pancreatic pseudocyst
Walled-off necrosis
Metal stent
Peripancreatic fluid collection
作者简介
通信作者：刘明东，Email：njglyy@163．com
