Successful Resolution of Gastric Outlet Obstruction Caused by Pancreatic Pseudocyst or Walled-Off Necrosis After Acute Pancreatitis: The Role of Percutaneous Catheter Drainage.
Successful Resolution of Gastric Outlet Obstruction Caused by Pancreatic Pseudocyst or Walled-Off Necrosis After Acute Pancreatitis: The Role of Percutaneous Catheter Drainage.
复制标题
成功解决急性胰腺炎后胰腺假性囊肿或围壁性坏死引起的胃出口梗阻
DOI：
10.1097/mpa.0000000000000429
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发表时间：
2015-11
期刊：
影响因子：
2.9
通讯作者：
Liang TB
中科院分区：
文献类型：
--
作者：
Zhang Y;Zhang SY;Gao SL;Liang ZY;Yu WQ;Liang TB
急性胰腺炎（AP）患者的胃排空延迟（DGE）可由胃轻瘫或胃出口梗阻引起，当胰腺假性囊肿（PP）或包裹性坏死（WON）压迫胃时可能发生这种情况。本研究的目的是探索一种合适的手术治疗方法。
2010年6月至2013年6月，148例AP患者中有25例发生DGE。其中12例由胃轻瘫引起，1例由白色念珠菌栓子梗阻导致，12例为胃出口梗阻（GOO），由PP（n = 8）或WON（n = 4）压迫所致，这些患者接受了经皮导管引流（PCD）治疗。
所有12例压迫性GOO患者在PP和WON分别经过6[1.86]天和37.25[12.02]天后通过PCD得以缓解。5例发生囊内感染，3例出现胰瘘，其中2例缓解，1例行假性囊肿空肠吻合术。
由PP或WON引起的胃出口梗阻是AP患者发生DGE的主要原因。由于安全性高且侵入性小，多部位、大管径经皮导管引流及灌洗可能是一种良好的治疗方法。
Objective Delayed gastric emptying (DGE) in patients with acute pancreatitis (AP) can be caused by gastroparesis or gastric outlet obstruction, which may occur when pancreatic pseudocyst (PP) or walled-off necrosis (WON) compresses the stomach. The aim of the study was to explore a proper surgical treatment. Methods From June 2010 to June 2013, 25 of 148 patients with AP suffered DGE. Among them, 12 were caused by gastroparesis, 1 was a result of obstruction from a Candida albicans plug, and 12 were gastric outlet obstruction (GOO) compressed by PP (n = 8) or WON (n = 4), which were treated by percutaneous catheter drainage (PCD). Results All 12 cases of compressing GOO achieved resolution by PCD after 6 [1.86] and 37.25 [12.02] days for PP and WON, respectively. Five cases developed intracystic infection, 3 cases had pancreatic fistulae whereas 2 achieved resolution and 1 underwent a pseudocyst jejunostomy. Conclusions Gastric outlet obstruction caused by a PP or WON is a major cause of DGE in patients with AP. Percutaneous catheter drainage with multiple sites, large-bore tubing, and lavage may be a good therapy due to high safety and minimal invasiveness.