内镜下经乳头引流术治疗胰腺假性囊肿的疗效观察(1)
摘 要：目的 探讨内镜下经乳头引流术治疗胰腺假性囊肿的疗效。方法 回顾性分析2011年1月～2016年10月在南昌大学二附院消化科收治并采用内镜下经乳头引流术治疗胰腺假性囊肿的患者30例的临床资料，分析其手术方式、效果及并发症情况。结果 28例患者一次性置管成功，2例不成功者该行外科手术；发生急性胰腺炎1例，2例术后出现高淀粉酶血症，均予抗感染、对症治疗后缓解；无十二指肠穿孔、出血、胆管炎及死亡病例；2例术后5周出现引流管堵塞，内镜下更换引流管。随访6～24个月，影像学显示24例假性囊肿完全消失，4例较前明显的缩小。腹痛腹胀症状消失。结论 内镜下乳头引流术是治疗胰腺假性囊肿的有效疗法。
关键词：胰腺假性囊肿；内镜；经乳头胰腺假性囊肿引流术
中图分类号：R576 文献标识码：B DOI：10.3969/j.issn.1006-1959.2018.23.055
文章编号：1006-1959(2018)23-0186-02
, http://www.100md.com
Abstract：Objective To investigate the efficacy of endoscopic transpapillary drainage in the treatment of pancreatic pseudocyst. Methods Clinical data of 30 patients admitted to the department of gastroenterology of the Second Affiliated Hospital of Nanchang University from January 2011 to October 2016 who were treated with endoscopic nipple drainage for pancreatic pseudocyst were retrospectively analyzed， and their surgical methods， effects and complications were analyzed. Results 28 patients were successfully treated with one-time catheterization and 2 patients were unsuccessful in the operation. Acute pancreatitis occurred in 1 case and hyperamylase in 2 cases postoperatively， all of which were relieved after anti-infection and symptomatic treatment. There were no cases of duodenal perforation， bleeding， cholangitis or death. In 2 cases， the drainage tube was blocked 5 weeks after surgery， and the drainage tube was replaced under endoscopy. Following up for 6 to 24 months， imaging showed that 24 cases of pseudocyst completely disappeared and 4 cases were significantly smaller than before. Abdominal pain and distension disappeared. Conclusion endoscopic nipple drainage is an effective treatment for pseudocyst of pancreas.Conclusion Endoscopic transpapillary cyst drainage is an effective treatment for pancreatic pseudocysts.
, 百拇医药
Key words：Pancreatic pseudocysts；Endoscope；Transpapillary pancreatic pseudocyst drainage
胰腺假性囊腫(pancreatic pseudocysts)是胰腺炎、胰腺外伤后最常见并发症，其主要为胰液通过破裂的胰管外溢，造成胰周渗液及坏死组织聚集，经周围组织包裹形成。大多数胰腺假性囊肿可自行吸收达到自愈，对有症状或出现并发症的胰腺假性囊肿需行外科手术或囊肿引流术，但对于胰腺假性囊肿的最佳治疗方案目前尚无确切的一致意见。内镜下经乳头胰腺假性囊肿引流术(endoscopic transpapillary cyst drainage，ETCD)可有效改善症状，逐渐得到应用。本文总结南昌大学二附院近5年来内镜下经乳头胰腺假性囊肿引流术患者资料，疗效满意，现报告如下。
1资料与方法
1.1一般资料 选择2011年1月～2016年10月在南昌大学第二附属医院行内镜下经乳头胰腺假性囊肿引流术患者资料，共30例。本研究经医院伦理委员会批准，排除胰腺囊腺瘤、胰腺囊腺癌患者。其中男18例，女12例；平均年龄(43.36±2.52)岁；主要表现为腹痛19例，伴发热1例，腹胀8例；腹部肿块3例；囊肿大小6.5～15 cm，平均(8.52±3.62)cm。其中胰头不22例，胰体6例，胰尾2例。
1.2手术方法 术前禁食6 h，术前30 min给予杜冷丁100 mg，山莨菪碱10 mg肌肉注射。取俯卧位，术者左手持十二指肠镜前端插入患者口中，进镜至贲门处，调整内镜，使内镜沿胃大弯侧进镜至幽门处，将幽门调整至视野中央偏低位置，进镜通过幽门进入十二指肠，旋转内镜进入降段，找到十二指肠乳头，以十二指肠乳头为标志，进行胰管插管。将导丝通过主胰管直接置入囊腔，切开胰管Oddis括约肌，然后沿导丝放入5～7F支架或鼻胆管引流。若坏死组织引流欠佳，根据具体情况留置多根引流管。术后24 h禁食。给予抗生素预防感染，并给予奥美拉唑抑酸、止血及补液等治疗。, http://www.100md.com(聂胜峰 曾志峰 丁洁)
关键词：胰腺假性囊肿；内镜；经乳头胰腺假性囊肿引流术
中图分类号：R576 文献标识码：B DOI：10.3969/j.issn.1006-1959.2018.23.055
文章编号：1006-1959(2018)23-0186-02
, http://www.100md.com
Abstract：Objective To investigate the efficacy of endoscopic transpapillary drainage in the treatment of pancreatic pseudocyst. Methods Clinical data of 30 patients admitted to the department of gastroenterology of the Second Affiliated Hospital of Nanchang University from January 2011 to October 2016 who were treated with endoscopic nipple drainage for pancreatic pseudocyst were retrospectively analyzed， and their surgical methods， effects and complications were analyzed. Results 28 patients were successfully treated with one-time catheterization and 2 patients were unsuccessful in the operation. Acute pancreatitis occurred in 1 case and hyperamylase in 2 cases postoperatively， all of which were relieved after anti-infection and symptomatic treatment. There were no cases of duodenal perforation， bleeding， cholangitis or death. In 2 cases， the drainage tube was blocked 5 weeks after surgery， and the drainage tube was replaced under endoscopy. Following up for 6 to 24 months， imaging showed that 24 cases of pseudocyst completely disappeared and 4 cases were significantly smaller than before. Abdominal pain and distension disappeared. Conclusion endoscopic nipple drainage is an effective treatment for pseudocyst of pancreas.Conclusion Endoscopic transpapillary cyst drainage is an effective treatment for pancreatic pseudocysts.
, 百拇医药
Key words：Pancreatic pseudocysts；Endoscope；Transpapillary pancreatic pseudocyst drainage
胰腺假性囊腫(pancreatic pseudocysts)是胰腺炎、胰腺外伤后最常见并发症，其主要为胰液通过破裂的胰管外溢，造成胰周渗液及坏死组织聚集，经周围组织包裹形成。大多数胰腺假性囊肿可自行吸收达到自愈，对有症状或出现并发症的胰腺假性囊肿需行外科手术或囊肿引流术，但对于胰腺假性囊肿的最佳治疗方案目前尚无确切的一致意见。内镜下经乳头胰腺假性囊肿引流术(endoscopic transpapillary cyst drainage，ETCD)可有效改善症状，逐渐得到应用。本文总结南昌大学二附院近5年来内镜下经乳头胰腺假性囊肿引流术患者资料，疗效满意，现报告如下。
1资料与方法
1.1一般资料 选择2011年1月～2016年10月在南昌大学第二附属医院行内镜下经乳头胰腺假性囊肿引流术患者资料，共30例。本研究经医院伦理委员会批准，排除胰腺囊腺瘤、胰腺囊腺癌患者。其中男18例，女12例；平均年龄(43.36±2.52)岁；主要表现为腹痛19例，伴发热1例，腹胀8例；腹部肿块3例；囊肿大小6.5～15 cm，平均(8.52±3.62)cm。其中胰头不22例，胰体6例，胰尾2例。
1.2手术方法 术前禁食6 h，术前30 min给予杜冷丁100 mg，山莨菪碱10 mg肌肉注射。取俯卧位，术者左手持十二指肠镜前端插入患者口中，进镜至贲门处，调整内镜，使内镜沿胃大弯侧进镜至幽门处，将幽门调整至视野中央偏低位置，进镜通过幽门进入十二指肠，旋转内镜进入降段，找到十二指肠乳头，以十二指肠乳头为标志，进行胰管插管。将导丝通过主胰管直接置入囊腔，切开胰管Oddis括约肌，然后沿导丝放入5～7F支架或鼻胆管引流。若坏死组织引流欠佳，根据具体情况留置多根引流管。术后24 h禁食。给予抗生素预防感染，并给予奥美拉唑抑酸、止血及补液等治疗。, http://www.100md.com(聂胜峰 曾志峰 丁洁)