超声内镜引导下穿刺引流治疗胰腺假性囊肿

目的探讨超声内镜引导下经胃肠壁穿刺置管引流治疗胰腺假性囊肿的疗效及并发症。方法选择2004年8月至2011年3月胰腺假性囊肿患者28例,首先使用线阵型超声内镜扫查,明确病变部位后选择合适穿刺点,导丝沿穿刺针道进入囊肿,沿导丝放置双猪尾硅胶支架1～3支。术后定期随访,囊肿消失后拔除支架。结果本组28例患者,穿刺引流成功25例,成功率为89．3％,其中经胃19例,经十二指肠6例。发生并发症3例,支架移位、出血、感染各1例。随访8—34个月,19例假性囊肿完全消失,6例腹痛症状消失、囊肿明显缩小、但持续存在2年以上,所有患者均未见假性囊肿复发。结论超声内镜引导下经胃肠壁穿刺置管引流术是治疗胰腺假性囊肿的较好方法之一,其疗效确切,并发症少。     

Endoscopic transmural drainage of pseudocysts associated with pancreatic resections or pancreatitis: a comparative study

Background  

Endoscopy has been regarded as an effective modality for draining pancreatic collections, pseudocysts, and abscesses. This study analyzes our experience with endoscopic transmural drainage of pancreatic pseudocysts and compares the outcomes in patients with postsurgical and pancreatitis-associated ones.     

不同胰管引流方式对胰十二指肠切除术后胰瘘的影响

目的:探讨不同胰管引流方式对胰十二指肠切除术(PD)术后胰瘘发生的影响。方法:回顾性分析第四军医大学附属第一医院西京医院2007年1月至2018年12月所有行PD的患者资料。共入组670例患者,其中男性415例,女性255例,年龄(58.4±7.3)岁,年龄范围24~82岁。按胰管引流方式的不同,进行倾向性评分匹配,分...     

Endoscopic pancreatic duct drainage and stenting for acute pancreatitis and pancreatic cyst and abscess

Background/Purpose Endoscopic drainage of pancreatic pseudocysts using transpapillary and transmural approaches has been reported. In this study, endoscopic nasopancreatic drainage (ENPD) and pancreatic stenting were performed in patients with pseudocyst and abscess associated with acute pancreatitis, and the usefulness and problems of the procedures were investigated. Methods After endoscopic retrograde pancreatography was done, ENPD and/or pancreatic stenting were performed in 13 patients with pancreatitis and pseudocyst or abscess that communicated with the main pancreatic duct. Results ENPD was performed in seven patients, and was effective in all five patients with cysts: the cysts disappeared or shrank. However, the condition in the two patients with abscess was unchanged, and percutaneous drainage was performed. Stenting was carried out in six patients, and the cyst disappeared or pancreatitis was improved in all six. The stent was removed from two patients, but no recurrence has been noted so far. Conclusions ENPD and stenting are effective therapeutic choices for acute and chronic pancreatitis and pseudocysts, and they are superior to percutaneous drainage to avoid pancreatic fistula, but they may not be effective for pancreatic abscess. Selection of therapeutic methods corresponding to individual cases is important.     

Endoscopic nasobiliary drainage for bile duct injury after laparoscopic cholecystectomy

Bile duct injuries are a potential complication of laparoscopic cholecystectomy (LC). A patient who underwent successful endoscopic nasobiliary drainage (ENBD) for a bile duct injury sustained during LC is presented. Of particular note, the patient also had Chilaiditi's syndrome. A 59-year-old woman was admitted with symptomatic cholecystolithiasis and Chilaiditi's syndrome. LC was performed. Postoperatively, the patient complained of abdominal discomfort. Laboratory examination revealed cholestasis. Bilious material began spilling from an intraabdominal drain. Subsequent endoscopic retrograde cholangiopancreatography (ERCP) showed bile leakage. ENBD was performed. Repeat ERCP 10 days later failed to show a bile leak or stenosis of the common bile duct. The patient improved rapidly and had no complaints after the procedure. ENBD is a useful endoscopic technique to prevent peritonitis from bile leakage after LC. Chilaiditi's syndrome is not a contraindication for LC.     

超声内镜下穿刺引流治疗感染性胰腺坏死：附60例报告

目的:探讨超声内镜(EUS)引导下穿刺引流术治疗感染性胰腺坏死(IPN)的临床疗效及安全性。方法:回顾性分析2013年1月—2018年12月中南大学湘雅三医院收治的60例行EUS引导下穿刺引流治疗的IPN患者临床资料,比较患者治疗前后生命体征、腹腔内压(IAP)、相关临床评分、实验室检查结果,并分析术后并发症及随访资料。结果:所有患者经EUS引导下穿刺引流术后,其生命体征、IAP、临床评分、实验室检查等指标较术前均得到明显改善(均P0.05);治疗结果为:治愈10例(16.7%)、明显好转46例(76.6%)、无效4例(6.7%),总有效率达到93.3%;术后严重并发症发生率16.7%,其中胰内瘘3例、肠外瘘1例、肠穿孔3例、出血3例,无手术相关的死亡。56例获随访,其中34例(60.7%)复查CT坏死灶基本吸收,临床症状消失、实验室检验指标无明显异常;10例半年内胰腺炎复发;7例胰腺外分泌功能不全;4例死亡。结论:EUS引导下穿刺引流术在治疗IPN方面,具有较好的临床疗效和安全性。     

Percutaneous transfistulous pancreatic duct drainage and interventional pancreatojejunostomy as a treatment option for intractable pancreatic fistula

We present 2 techniques for treatment of intractable pancreatic fistula: percutaneous transfistulous pancreatic duct drainage and interventional pancreatojejunostomy. Percutaneous transfistulous pancreatic duct drainage can be effective for intractable fistulas that communicate with the main pancreatic duct. Because drainage itself is not enough for a complete cure of this complication when it occurs in cases after pancreatoduodenectomy (PD), interventional pancreatojejunostomy is applicable.     

经皮经肝胆管引流术治疗肝移植相关性胆瘘

目的 探讨经皮经肝胆管引流术(PTBD)治疗肝移植(OLT)相关性胆瘘的方法 及疗效.方法 回顾性分析经PTBD治疗的7例OLT相关性胆瘘,OLT术后受体胆瘘6例,活体肝移植(LDLT)供体胆瘘1例.吻合口瘘6例(1例合并吻合口狭窄),其中2例合并肝动脉狭窄;肝切缘小胆管残端瘘1例.引流方式采用外引流,引流管前端跨过瘘口部位,成畔固定于胆总管内.瘘口闭合、腹腔引流管无胆汁引出为治愈.结果 7例胆瘘病人PTBD引流量180～450 ml/d,经引流21～87 d(中位时间62 d)后,复查造影瘘口闭合,胆瘘治愈率为7/7.随访时间93～675 d(中位时间124 d),4例无症状生存,2例因多器官功能不全放弃治疗,1例肝癌复发病死.1例在引流期间出现胆道感染.结论 PTBD是治疗0LT相关性胆瘘的一种安全、简便、有效的方法 .     

Endoscopic retrograde drainage for bile duct cancer

Endoscopic biliary drainage is a palliative measure. It is mainly indicated for inoperable malignant jaundice. Extrahepatic obstructions are suitable for the transpapillary decompression, which may be successful in 80–90% of patients. Morbidity and mortality rates are approximately 5% and 1–2%, respectively. Tumors of the hilum region, which usually already involve the intrahepatic ducts, are less eligible for drainage treatment. In the case of insufficient drainage, cholangitis may occur. A satisfactory decompression can only be achieved if both hepatic ducts are catheterized. Apart from the technique, the long-term results of the drainage treatment also depend on the consistency of the follow-up. A regular check of the patients is required because, after an average of 3 months, the biliary stent may be occluded, which is usually followed by cholangitis.

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Resumen El drenaje biliar endoscópico es una medida paliativa; está principalmente indicada en la ictericia por neoplasia maligna. Las obstrucciones extrahepáticas son susceptibles de descompresión transpapilar, procedimiento que puede ser exitoso en 80–90% de los pacientes. La morbilidad y mortalidad son del orden de 5% y 1–2%, respectivamente. Los tumores de la región biliar, que usualmente presentan invasión de los canales intrahepáticos, son menos adecuados para drenaje. La colangitis puede ocurrir cuando el drenaje ha sido insuficiente, y una descompresión verdaderamente satisfatoria sólo puede ser lograda cuando ambos canales hepáticos son cateterizados. Aparte de la técnica utilizada, los resultados a largo término del tratamiento mediante drenaje también dependen de la consistencia del seguimiento. Se requiere un programa regular de control de los pacientes, porque después de los 3 meses los catéteres biliares pueden ocluirse, lo cual generalmente da lugar a colangitis.

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Résumé Le drainage biliaire rétrograde constitue une méthode palliative de traitement. Il est indiqué essentiellement lorsque l'ictère néoplasique ne peut Être traité chirurgicalement. Les obstructions extra-hépatiques relèvent de cette méthode qui est efficace dans 80–90% des cas. Les taux de morbidité et de mortalité sont respectivement de 5% et de 1–2% environ. Les tumeurs biliaires qui envahissent rapidement les canaux biliaires intra-hépatiques répondent plus rarement à cette méthode. Lorsque le drainage est insuffisant l'angiocholite est une complication fréquente. La décompression biliaire qu'il exerce n'est efficace que si les deux canaux hépatiques sont drainés. Le résultat à long terme du drainage dépend d'une surveillance stricte. Les malades doivent Être examinés à intervalles réguliers car après 3 mois en moyenne l'obstruction du drain n'est pas rare, obstruction à l'origine de l'angiocholite.

     

内镜下乳头气囊扩张术在胆总管探查取石中的应用

目的: 探讨内镜下乳头气囊扩张术(endoscopic papillary balloon dilatation,EPBD)在胆总管探查取石中的应用价值. 方法: 对经EPBD探查取石治疗的10例拟诊胆总管结石病人的临床资料作回顾分析. 结果: 10例病人术前影像学检查均提示胆总管结石,在按常规行ERCP时,发现7例与术前诊断相符,并经EPBD后取出结石,结石大小均在0.5cm左右.3例病人行ERCP时未能肯定胆总管内有否结石,经EPBD后用网篮及气囊探查未取出结石.全组病人行EPBD均获成功,无因内镜操作所致的并发症发生. 结论: EPBD保留了乳头括约肌的正常生理功能,不会引起内镜括约肌切开术(endoscopic sphincterotomy,EST)后的出血、穿孔以及日后的胆肠返流等并发症.是一种安全有效、并发症少的治疗方法,有望替代部分括约肌切开术.     

Endoscopic stent placement for pancreaticocutaneous fistula after surgical drainage of the pancreas

BACKGROUND: Spontaneous closure of an external pancreatic fistula is unlikely when a concomitant downstream obstruction of the pancreatic duct inhibits downstream flow. Early endoscopic retrograde pancreatography (ERP) and stent insertion may enhance fistula closure in these patients. METHODS: The results of endoscopic stenting of the pancreatic duct were evaluated in 15 patients with an external pancreatic fistula that developed after operative necrosectomy and debridement of the pancreas (seven men and eight women, median age 45 (range 25-68) years). RESULTS: Median drainage before ERP was 50-800 ml/day, with an amylase content of 210,00-493,000 units/l. ERP was performed after a median time of 35 days and revealed leakage of the duct and a downstream obstruction in all patients. An endoprosthesis was inserted beyond the site of obstruction. Within a median time of 10 (range 2-64) days drainage stopped in all patients. In one patient ERP failed and pancreaticojejunostomy was performed. During follow-up (median 24 (range 2-55) months) three patients required resection of the pancreatic tail because of pseudocyst formation, all of whom originally had leakage from the tail area. CONCLUSION: Based on these data, an active approach for external pancreatic fistula seems warranted. Early ERP and stent insertion enhances fistula resolution, facilitates wound care and surgery is postponed or even avoided.     

Endoscopic ultrasound-guided transmural stenting for gallbladder drainage in high-risk patients with acute cholecystitis: a systematic review and pooled analysis

Background

Endoscopic ultrasound-guided transmural stenting for gallbladder drainage is an emerging alternative for the treatment of acute cholecystitis in high-risk surgical patients. A variety of stents have been described, including plastic stents, self-expandable metal stents (SEMSs), and lumen-apposing metal stents (LAMSs). LAMSs represent the only specifically designed stent for transmural gallbladder drainage. A systematic review was performed to evaluate the feasibility and efficacy of EUS-guided drainage (EUS-GBD) in acute cholecystitis using different types of stents.

Methods

A computer-assisted literature search up to September 2015 was performed using two electronic databases, MEDLINE and EMBASE. Search terms included MeSH and non-MeSH terms relating to acute cholecystitis, gallbladder drainage, endoscopic gallbladder drainage, endoscopic ultrasound gallbladder drainage, alone or in combination. Additional articles were retrieved by hand-searching from references of relevant studies. Pooled technical success, clinical success, and adverse event rates were calculated.

Results

Twenty-one studies met the inclusion criteria, and the eligible cases were 166. The overall technical success rate, clinical success rate, and frequency of adverse events were 95.8, 93.4, and 12.0 %, respectively. The technical success rate was 100 % using plastic stents, 98.6 % using SEMSs, and 91.5 % using LAMSs. The clinical success rate was 100, 94.4, and 90.1 % after the deployment of plastic stents, SEMSs, and LAMSs, respectively. The frequency of adverse events was 18.2 % using plastic stents, 12.3 % using SEMSs, and 9.9 % using LAMSs.

Conclusions

Among the different drainage approaches in the non-surgical management of acute cholecystitis, EUS-guided transmural stenting for gallbladder drainage appears to be feasible, safe, and effective. LAMSs seem to have high potentials in terms of efficacy and safety, although further prospective studies are needed.

     

胰管栓塞预防胰十二指肠切除术后胰瘘的作用分析

目的 探讨胰十二指肠切除术(PD)采取胰管栓塞的方法,以达到预防胰瘘的目的。方法 PD术中从胰管断端插管注入“TH”粘胶栓塞胰管,消化道重建按Child术式进行。结果 在PD术中共行胰管栓塞12例,均未发生胰瘘。结论 胰管栓塞可有效地预防PD术后胰瘘,尤适用于基层医院。     

Endoscopic drainage for pancreatic pseudocyst in children

The authors report here the results of endoscopic cystogastrostomy performed on 3 children aged 11, 3, and 2.5 years with nonresolving pancreatic pseudocyst (PP) of 12, 9.5, and 7 cm in diameter. The etiology of PP was abdominal trauma in 2 and idiopathic acute pancreatitis in 1 case. Ultrasound and computed tomography scans confirmed the diagnosis and suitability for gastric drainage. After the puncture of cyst, a double pig-tail stent was placed for the permanent drainage of cystogastrostomy. Complete regression was confirmed by follow-up ultrasonography at 8, 6, and 7 weeks, respectively. There were no procedure-related complications, nor was there a recurrence of cyst during the 2 years of follow-up. This report suggests that children with nonresolving PP, that are anatomically accessible, can be treated successfully and safely by endoscopic drainage.