超声内镜引导下经胃穿刺胆道覆膜金属支架引流术治疗胰腺假性囊肿患者的护理

目的探讨应用超声内镜(endoscopic ultrasonography,EUS)引导下经胃穿刺胆道覆膜自膨式金属支架引流术治疗胰腺假性囊肿患者的护理方法。方法回顾性分析并总结2013年9月至2014年10月在第二军医大学长海医院接受超声内镜引导下经胃穿刺胆道覆膜自膨式金属支架引流术的12例胰腺假性囊肿患者的临床资料。结果 12例患者均完成经胃穿刺、全覆膜金属支架置入引流术,手术成功率为100%;3例患者并发感染,1例患者发生支架移位,无出血、穿孔、病死病例;其中7例已完成支架拔除术,囊肿均完全消失。结论 EUS引导下经胃穿刺胆道覆膜金属支架引流术治疗胰腺假性囊肿是一项安全有效的治疗方法,而围术期的精心护理是保证手术顺利进行及手术疗效的必要条件。     

超声内镜引导下经胃肠道胰腺假性囊肿引流治疗： 疗效、安全性的分析报道

目的观察超声内镜(EUS)引导下经胃肠道胰腺假性囊肿引流的疗效及安全性。方法选择2008年1月~2012年12月共31例胰腺假性囊肿患者,行EUS引导下经胃肠道引流,囊肿平均最大直径9.5 cm(5~20 cm),在超声引导下选择穿刺点,用穿刺针穿刺后放r置导丝,分别使用针形刀(14例)及囊肿切开刀(11例)切开后,置双猪尾或鼻囊管引流。结果 31例患者中1例未能成功放置引流管引流,随访5~18个月中,3例患者术后复发并再次行EUS引导下经胃肠道引流,未成功1例转外科手术治疗,术后2例患者术后出现腹膜炎,其中1例行手术治疗,另1例经内科保守治疗好转,无出血发生,无死亡发生。结论超声内镜引导下经胃肠道胰腺假性囊肿引流术是一种安全、有效且并发症少、创伤小的方法。     

超声内镜下经胃、十二指肠乳头引流治疗胰腺假性囊肿的效果评价*

目的探究超声内镜(EUS)下经胃或十二指肠乳头置管引流治疗胰腺假性囊肿(PPC)的临床疗效。方法选取2012年3月-2015年3月该院收治的100例PPC患者,按临床治疗指标对其中的80例进行EUS下经胃穿刺置管引流,20例行EUS下经十二指肠乳头穿刺置管引流。记录所有患者的治疗效果以及并发症的发生情况。结果 100例患者的手术中成功率为95.00%,其中囊肿完全消失率为84.00%。100例患者中共有10例发生术中出血,3例发生支架移位堵塞,另有7例术后出现囊肿内部感染,并发症的发生率为20.00%。结论对PPC患者进行EUS下经胃、十二指肠乳头穿刺置管引流治疗可以提高临床疗效,减少并发症,值得在临床上推广应用。     

内镜超声引导下胰腺假性囊肿经胃置管引流术的护理

目的探讨内镜超声（endoscopic ultrasonography,EUS）引导下胰腺假性囊肿经胃置管引流术的护理。方法回顾性总结2004年1月至2009年4月在EUS引导下行胰腺假性囊肿经胃置管引流术15例患者的临床资料及围术期护理措施。结果 15例患者均完成囊肿穿刺、置管,手术成功率为100%;发生并发症3例（20.0%）,其中胃壁出血2例、感染1例。手术后9例患者囊肿完全消失,4例患者囊肿较术前缩小50%,总有效率为86.7%（13/15）;术后随访3～6个月无复发。结论 EUS引导下胰腺假性囊肿经胃置管引流术是一种治疗价值高、安全、有效、并发症少的治疗方法 ,行之有效的护理配合是取得满意疗效的重要保证。     

经胃内镜超声引导下胰腺假性囊肿管型刀电切造瘘治疗

目的通过内镜超声（EUS）引导下经胃对胰腺囊肿进行电切造瘘，来达到充分引流囊肿、避免感染和囊肿复发的目的，并评价该方法的安全性。方法研究对象为25例胰腺囊肿患者，其中男11例，女14例，囊肿平均直径8cm（5～12cm），胰头部囊肿3例，胰体部、胰尾部囊肿各11例，应用大腔道超声内镜进行EUS检查，选择合适的穿刺位置，将穿刺针刺入囊肿中心，将导丝置入囊内，沿导丝插入10F管型高频电切刀对胃壁和囊壁实施高频电切造瘘，电切完成后沿导丝置入10F双猪尾支架。术后临床观察，1周后复查CT和EUS，以后每个月复查CT1次。结果全部患者均未发生感染、出血、穿孔等并发症，术后1周时，24例患者CT检查囊肿基本消失，1例患者囊肿明显缩小，2个月后消失。内镜下见瘘道通畅，痿道直径0．8～1．5cm，术后随访3个月后拔出引流管，随访6～10个月未见囊肿复发。讨论EUS引导下经胃对胰腺囊肿管型刀电切造瘘治疗是治疗胰腺囊肿快速有效的方法，并且这种方法是安全的。     

超声引导下经皮穿刺置管引流治疗胰腺假性囊肿16例分析

目的：探讨胰腺假性囊肿超声引导下经皮穿刺置管引流治疗的临床价值。方法：采用超声引导经皮穿刺治疗胰腺假性囊肿16例,其中单纯抽液1例,置管引流15例。结果：16例穿刺16次,共放入引流管15根,1例因囊腔与主胰管相通,改行开腹囊肿空肠Roux-Y吻合术,引流时间2周~6个月,临床治愈率96%,未见复发,无并发症。结论：超声引导下经皮穿刺置管引流治疗胰腺假性囊肿具有创伤小、疗效好、并发症少、可重复的优点,为临床提供了一种简便易行、疗效显著的微创治疗途径,可作为胰腺假性囊肿的首选治疗方法。     

9例胰腺假性囊肿超声内镜下经胃穿刺内引流的护理

[目的]探讨护理措施在保证超声内镜（EUS）引导下胰腺假性囊肿穿刺内引流术的顺利进行、减少并发症、降低复发率中的作用。[方法]对9例符合超声内镜引导下胰腺囊肿穿刺内引流适应证的病人,术前做好心理护理、术前指导、物品器械准备、病人准备并签署知情同意书,术中严密观察病情变化,做好手术配合。术后加强病情监测,注意并发症的预防和处理,做好饮食护理和用药指导及出院健康宣教,嘱病人定期随访。[结果]穿刺置管成功率为100%。4例囊肿完全消失,5例囊肿较术前缩小〉50%,术后随访3个月~6个月无复发。4例中2例手术当日呼吸得到明显改善,1例术后第2天黄疸明显消退,1例术后并发出血经治疗后痊愈。[结论]对超声内镜引导下胰腺假性囊肿穿刺治疗的病人采取有效的护理措施是保证手术成功的必备条件。     

9例胰腺假性囊肿超声内镜下经胃穿刺内引流的护理

[目的]探讨护理措施在保证超声内镜(EUS)引导下胰腺假性囊肿穿刺内引流术的顺利进行、减少并发症、降低复发率中的作用。[方法]对9例符合超声内镜引导下胰腺囊肿穿刺内引流适应证的病人,术前做好心理护理、术前指导、物品器械准备、病人准备并签署知情同意书,术中严密观察病情变化,做好手术配合。术后加强病情监测,注意并发症的预防和处理,做好饮食护理和用药指导及出院健康宣教,嘱病人定期随访。[结果]穿刺置管成功率为100%。4例囊肿完全消失,5例囊肿较术前缩小>50%,术后随访3个月~6个月无复发。4例中2例手术当日呼吸得到明显改善,1例术后第2天黄疸明显消退,1例术后并发出血经治疗后痊愈。[结论]对超声内镜引导下胰腺假性囊肿穿刺治疗的病人采取有效的护理措施是保证手术成功的必备条件。     

胰管内外引流治疗胰腺假性囊肿疗效分析

目的 分析内镜下经十二指肠乳头胰管内外引流治疗胰腺假性囊肿的临床疗效.方法 对该院消化内镜中心治疗的胰腺假性囊肿病例进行回顾性分析,总结内镜治疗效果,评估该治疗方法的临床疗效.结果 经内镜逆行胰胆管造影(ERCP)证实为交通性胰腺假性囊肿并接受内镜治疗的病例31例.经乳头括约肌切开(EST)和胰管括约肌切开(EPS)术后,初次引流全部成功.其中鼻胰管引流(ENPD)8例;胰管支架(ERPD)10例;ENPD+ERPD 13例.术后出现囊肿感染4例,感染率13%(4/31).经更换支架或反复冲洗,并加强抗感染治疗,治愈;2例转外科手术治疗,其中1例因胰腺假性囊肿多分隔,内镜下引流效果不佳,反复出现感染症状而转外科手术治疗,另外1例胰腺假性囊肿患者因引流液中查到异型细胞,考虑胰腺癌不排除而转手术切除,病理结果为胰腺癌;囊肿复发1例,再次给予ERPD引流后治愈;胰腺假性囊肿残腔形成1例.无出血、穿孔、死亡等并发症发生.胰管支架放置至囊肿消失时间平均3个月,平均住院40.6d.结论 内镜经乳头引流治疗交通性胰腺假性囊肿是一种确切有效的治疗方法,合理应用,控制和预防感染是治疗的关键,应该得到重视.     

超声内镜引导下置入支架行胰腺假性囊肿胃内引流术的护理

我科自2008年4月-2009年8月收治胰腺假性囊肿5例,患者在超声内镜引导下置入支架行胰腺假性囊肿胃内引流术,治疗效果显著,无并发症发生,现报告如下。     

Utility of endoscopic ultrasonography in endoscopic drainage of pancreatic pseudocysts in selected patients

OBJECTIVES: To determine the effect of endoscopic ultrasonography (EUS) on endoscopic drainage of pancreatic pseudocysts and to determine patency with fistula dilation and placement of multiple stents. PATIENTS AND METHODS: Between September 1995 and January 1999, 19 patients underwent endoscopic drainage of pancreatic pseudocysts, 17 of whom were assessed by EUS before drainage. Radial EUS scanning was used to detect an optimal site of apposition of pseudocyst and gut wall, free of intervening vessels. A fistula was created with a fistulatome, followed by balloon dilation of the fistula tract. Patency was maintained with multiple double pigtail stents. The primary goal of this retrospective study was to determine whether EUS affected the practice of endoscopic drainage of pancreatic pseudocysts. RESULTS: In 3 patients, drainage was not attempted based on EUS findings. In the other 13 patients (14 pseudocysts), creation of a fistula was successful on 13 occasions, and no immediate complications occurred. However, 1 patient subsequently developed sepsis that required surgery. All other patients were treated with balloon dilation, multiple stents, and antibiotics, with no septic complications. Of 14 pseudocysts (in 13 patients), 13 (93%) resolved. CONCLUSIONS: Results of EUS may alter management of patients considered for endoscopic drainage of pancreatic pseudocysts. Endoscopic ultrasonography was useful for selecting an optimal and safe drainage site. The combination of balloon dilation, multiple stents, and antibiotics appears to resolve pancreatic pseudocysts without septic complications.     

胰管塑料支架和/或鼻胆管引流在内镜逆行胰胆管造影术选择性胆管插管困难时的应用研究

目的探讨胰管塑料支架和/或鼻胆管引流在胆总管结石患者内镜逆行胰胆管造影术(ERCP)选择性胆管插管困难(DSBC)时的应用。方法回顾性分析57例ERCP术中DSBC的胆总管结石患者的临床资料,将患者分为胰管塑料支架组、鼻胆管引流组、胰管塑料支架+鼻胆管引流组,观察其手术成功率、术后并发胰腺炎、高淀粉酶血症或其他并发症的发生率,对比分析3组间的差异。结果接受ERCP的57例患者中,胰管塑料支架组13例患者,手术成功2例(15.4%),高淀粉酶血症1例(7.7%),术后胰腺炎2例(15.4%),发热1例(7.7%),出血1例(7.7%);鼻胆管引流组20例患者,手术成功20例(100.0%),无高淀粉酶血症及术后胰腺炎,无出血及发热等并发症的发生;胰管塑料支架+鼻胆管引流组24例患者1次ERCP手术成功19例(79.2%),2次ERCP成功5例(20.8%),4例出现高淀粉酶血症(16.7%),2例出现出血(8.3%),无发热及术后胰腺炎。3组间比较术后胰腺炎的发生和手术成功率差异有统计学意义。结论 ERCP术中DSBC的患者可通过放置胰管支架和/或鼻胆管引流术提高手术的成功率,减少胰腺炎的发生。     

Endoscopic drainage of pancreatic pseudocysts: long-term outcome and procedural factors associated with safe and successful treatment

BACKGROUND AND STUDY AIMS: Endoscopic drainage is a widely used treatment modality for pancreatic pseudocysts and has challenged more traditional drainage techniques. This retrospective study evaluates the short-term and long-term results with this technique and aims to identify procedural modifications that may improve its safety and efficacy. PATIENTS AND METHODS: All consecutive patients who underwent endoscopic drainage of pancreatic pseudocysts in our hospital between 1983 and 2000 were included in the study. The patients' charts were reviewed, and long-term follow-up data were obtained by written questionnaires sent to the patients at the end of the follow-up period in November 2002. RESULTS: A total of 92 patients were included (66 men, 26 women; median age 49 years). The technical success rate of the drainage procedure was 97 % and the mortality rate was 1 %. Complications occurred in 31 patients (34 %), eight of which (9 %) were major and required surgery: hemorrhage in four cases (three of which were caused by erosion of a straight endoprosthesis through the cyst wall), secondary infection in three, and perforation in one. During a median follow-up period of 43 months, 10 patients (11 %) underwent additional (nonendoscopic) treatment for a persistent cyst and five (5 %) for a recurrent cyst. Overall, endoscopic drainage was successful in 65 patients (71 %). CONCLUSIONS: Endoscopic drainage is an effective treatment for pancreatic pseudocysts and offers a definitive solution in almost three-quarters of the cases. The majority of major complications might have been prevented by using pigtail stents instead of straight stents and by taking a more aggressive approach to the prevention and treatment of secondary cyst infection.     

免X线超声内镜下透壁引流治疗胰腺假性囊肿的单中心回顾性分析

目的 探讨免X线超声内镜下胰腺假性囊肿（PPC）透壁引流，对比传统X线引导下透壁引流的临床效果和安全性。方法 回顾性分析2018年1月－2021年6月就诊于该院的33例行超声内镜下PPC透壁引流术患者的临床资料。其中，免X线组14例和X线引导组19例，比较两组患者手术成功率、手术时间和并发症发生率等。结果 33例PPC患者均成功完成手术（100.00%），免X线组手术时间为（28.30±13.00）min，明显短于X线引导组的（46.79±18.00）min，差异有统计学意义（P < 0.05）。免X线组2例（14.29%）出现术后并发症。其中，1例患者由于合并部分包裹性坏死，治疗后出现了感染和发热，抗感染治疗效果不理想，再次进行超声内镜下鼻胆管引流后，症状改善；另1例由于合并区域性门静脉高压症，术后出现上消化道出血，行介入治疗后，痊愈出院。X线引导组术后并发症4例（21.05%）。其中，2例因出现囊腔内感染而再次引流；2例出现上消化道出血，1例保守治疗成功，1例行开腹手术止血治疗和囊肿外引流术。结论 单纯性PPC行免X线超声内镜下透壁引流术，安全、有效，手术时间短，且内镜医生能够避免X线辐射损伤，值得临床推广。     

Treatment of infected pancreatic pseudocysts by endoscopic ultrasonography-guided cystogastrostomy

It has been appreciated for a long time that surgery is the treatment of choice for symptomatic, and especially infected, pancreatic pseudocysts. This paradigm is now being challenged by endoscopic cystoenterostomy and cystogastrostomy, which have both been employed with success in selected patients. We present three cases in which infected pancreatic pseudocysts resolved following endoscopic cystogastrostomy guided by endoscopic ultrasonography (EUS).     

Endoscopic management of pancreatic pseudocysts.

Pancreatic pseudocysts occur as a consequence of acute pancreatitis, chronic pancreatitis, or pancreatic trauma. Pseudocysts that are symptomatic, complicated, or enlarging with time can be treated surgically, via percutaneous drainage, or by endoscopic methods. Currently, there are two endoscopic approaches for managing pancreatic pseudocysts: transpapillary and transmural. Endoscopy nurses play an important role in the care of patients before, during, and after an endoscopic drainage procedure. This article reviews the indications, techniques, potential complications, limitations, and nursing care involved in endoscopic management of pancreatic pseudocysts.     

Prothèses biliaires et pancréatiques : indications,résultats et techniques

Biliary and pancreatic stents are used in several indications. Among them, the most frequent are benign and malignant biliary strictures andWirsung stenosis, most often in patients with chronic pancreatitis. Biliary fistula and big stones are other possible indications. Self-expandable metal stents are indicated in pancreatic cancers and common bile duct cancers, without restrictions in palliative situations and under certain conditions in pre-operative situation. Benign biliary strictures are currently treated by multiple plastic stents. Recent studies however suggest that self-expandable metal stents could be suitable in these cases, with same results as plastic stents. Wirsung strictures in patients with chronic pancreatitis can be treated by one or several plastic stents. A few studies suggest an equivalent efficiency of full-covered self-expandable metal stents. When retrograde endoscopic approach is not possible, the option of an endoscopic ultrasonography guided drainage could be considered.     

OTSC金属夹治疗难治性急性非静脉曲张性上消化道出血的效果评估

目的探讨内镜下OTSC金属夹闭合术在难治性急性非静脉曲张性上消化道出血(ANVUGIB)治疗中的疗效。方法对滨州医学院附属医院消化内科2015年1月1日-2016年6月1日通过OTSC金属夹治疗的16例难治性ANVUGIB的患者进行回顾性分析。其中贲门黏膜撕裂并出血2例,胃溃疡出血7例,胃癌1例,十二指肠球部溃疡出血6例。结果 16例患者均成功的进行了内镜下止血,成功率100.0%,止血夹自安装至释放成功平均所需时间仅为5.0~6.0 min。结论 OTSC在难治性ANVUGIB患者中的治疗安全、有效,值得临床推广。     

Interventional ultrasound-guided procedures in pancreatic pseudocysts, abscesses and infected necroses - treatment algorithm in a large single-center study

Through a time period of 5 years, all consecutive patients were documented in this prospective single centre observational clinical study to investigate feasibility and outcome of ultrasound(US)- and EUS-guided drainage of symptomatic non-infected pancreatic pseudocysts and abscesses as well as the endoscopic debridement of infected necroses. RESULTS: From 03 / 23 / 2002 to 12 / 31 / 2008, 147 patients (females:males = 49:98 [1:2.0]) with pseudocysts (n = 32), abscesses (n = 81) and necroses (n = 34) were enrolled in the study. Technical success rate in US-guided external and in EUS-guided transmural drainage was 100 % and 97.0 %, respectively, whereas that of transpapillary (ERP-guided) drainage was 92.1 %. While the complication rate in external drainage was 3.7 %, this rate in transmural and transpapillary drainage was 9.6 % and 0, respectively. Late complications (> 24 h) were observed in 6.4 % of patients after transpapillary drainage (external drainage, 5.6 %; transmural drainage, 19.1 %). Complications in 5 cases (bleeding, n = 3; perforation, n = 1; dislocation of the prosthesis with perforation of the terminal ileum, n = 1) needed to be approached surgically. After a mean follow-up period of 20.7 months, 20.9 months, and 19.4 months, the definitive therapeutic success rate was 96.2 % in average for the three diagnoses such as pseudocyst (96.9 %), abscess (97.5 %), and necrosis (94.1 %), respectively (recurrency rate, 15.4 % in average; overall mortality, 0.7 % but no intervention-related death). CONCLUSION: US- and endoscopy-based management of pancreatic lesions as reported is suitable and favorable also in daily clinical routine since it is a safe and efficacious approach in experienced hands.     

Therapeutic pancreatic endoscopy

A number of endoscopic interventions have expanded the range of treatment options in symptomatic pancreatic diseases. Early endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) appear to be beneficial in patients with severe acute biliary pancreatitis. Endoscopic pancreatic sphincterotomy can be safely performed with high technical success rates in patients with chronic pancreatitis. Routine additional biliary ES or drainage procedures are not apparently necessary. Stenting can be limited to the treatment of dominant pancreatic duct strictures. In patients with sphincter of Oddi dysfunction, temporary placement of pancreatic stents reduces the morbidity associated with ES. Transpapillary or transmural endoscopic drainage achieves resolution of pancreatic pseudocysts in the majority of selected patients. Drainage procedures with endoscopic ultrasound guidance can potentially expand the indications and reduce the procedure-related morbidity. Therapeutic endoscopy should be considered in symptomatic patients with pancreas divisum, as well as in selected children with pancreatic diseases. Most of the published studies on therapeutic pancreatic endoscopy have been conducted retrospectively. Additional prospective controlled trials are warranted to allow further evaluation of the impact of these methods on the clinical outcome in comparison with alternative treatment strategies.