LONG-TERM RESULTS AFTER ENDOSCOPIC DRAINAGE AND NECROSECTOMY OF SYMPTOMATIC PANCREATIC FLUID COLLECTIONS
LONG-TERM RESULTS AFTER ENDOSCOPIC DRAINAGE AND NECROSECTOMY OF SYMPTOMATIC PANCREATIC FLUID COLLECTIONS
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DOI：
10.1111/j.1443-1661.2011.01162.x
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发表时间：
2012-01-01
影响因子：
5.3
通讯作者：
Soehendra, Nib
中科院分区：
文献类型：
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作者：
Seewald, Stefan;Ang, Tiing Leong;Soehendra, Nib
目的：探讨内窥镜引流和坏死性切除术治疗症状性胰液收集的近期和长期效果。方法：回顾性分析1997年10月至2008年3月行内镜治疗的80例有症状的胰腺积液患者（平均直径11.7 cm，范围3 ~ 20；假性囊肿24/80，脓肿20/80，感染性壁闭塞性坏死36/80）的资料。结果：内镜下引流技术包括超声内镜引导下的抽吸（2/80）、超声引导下的经肠引流（70/80）和非超声引导下的经肠瘘引流（8/80）。内镜下坏死切除术49/80例（脓肿14/20例；感染坏死35/36例）。手术并发症为出血（12/80）、穿孔（7/80）、门静脉空气栓塞（1/80）和Ogilvie综合征（1/80）。78/80（97.5%）获得初步技术成功，67/80（83.8%）在内镜下获得收集物的临床分辨率，13/80需要手术（穿孔4例，内镜下无法到达的区域2例，引流不足7例）。6个月内，5例患者因反复积液需要手术；在平均31个月的随访中，又有4例患者由于潜在的胰管异常而无法通过内窥镜治疗而复发，因此需要手术治疗。内镜治疗的长期成功率为58/80（72.5%）。结论：内镜下引流有症状的胰液是安全有效的，具有良好的近期和远期效果。内窥镜下坏死切除术有严重并发症的风险。潜在的胰管异常必须解决，以防止再次液体收集。
Aims: To determine the immediate and long-term results of endoscopic drainage and necrosectomy for symptomatic pancreatic fluid collections.Methods: The data of 80 patients with symptomatic pancreatic fluid collections (mean diameter: 11.7 cm, range 3-20; pseudocysts: 24/80, abscess: 20/80, infected walled-off necrosis: 36/80) referred for endoscopic management from October 1997 to March 2008 were analyzed retrospectively.Results: Endoscopic drainage techniques included endoscopic ultrasound (EUS)-guided aspiration (2/80), EUS-guided transenteric drainage (70/80) and non-EUS-guided drainage across a spontaneous transenteric fistula (8/80). Endoscopic necrosectomy was carried out in 49/80 (abscesses: 14/20; infected necrosis: 35/36). Procedural complications were bleeding (12/80), perforation (7/80), portal air embolism (1/80) and Ogilvie Syndrome (1/80). Initial technical success was achieved in 78/80 (97.5%) and clinical resolution of the collections was achieved endoscopically in 67/80 (83.8%), with surgery required in 13/80 (perforation: four; endoscopically inaccessible areas: two; inadequate drainage: seven). Within 6 months five patients required surgery due to recurrent fluid collections; over a mean follow up of 31 months, surgery was required in four more patients due to recurrent collections as a consequence of underlying pancreatic duct abnormalities that could not be treated endoscopically. The long-term success of endoscopic treatment was 58/80 (72.5%).Conclusions: Endoscopic drainage of symptomatic pancreatic fluid collections is safe and effective, with excellent immediate and long-term results. Endoscopic necrosectomy has a risk of serious complications. The underlying pancreatic duct abnormalities must be addressed to prevent recurrence of fluid collections.