假性胰腺囊肿的内镜治疗

目的 观察经十二指肠乳头引流治疗胰腺假性囊肿的疗效以及并发症，探讨新的微创治疗方法。方法 选择胰腺假性囊肿患者8例，均有2次以上外科手术史，再次外科手术难度较大。经内镜逆行胰胆管造影(ERCP)后，十二指肠乳头、主胰管括约肌切开，行内引流管置人或主胰管探条扩张治疗，囊肿消失后经内镜取出内引流管。结果 ERCP提示，3例囊肿与主胰管相通，l例囊肿压迫造成胆总管下段狭窄梗阻。置入内引流管5例；探条扩张治疗3例。术后l～4个月囊肿完全消失7例；l例囊肿缩小约l／3，临床症状消失，随访6个月囊肿未再缩小，转外科手术治疗。术后2例出现一过性血、尿淀粉酶升高，无严重并发症发生。结论：ERCP及其派生的治疗技术，治疗胰腺假性囊肿有效、安全，可作为胰腺假性囊肿的微创治疗方法。

Treatment of pancreatic pseudocysts by therapeutic ERCP

Objective To determine the effect of therapeutic ERCP(endoscopic retrograde cholan-giopancreatography) on endoscopic drainage of pancreatic pseudocysts and patency of main pancreatic duct after dilation or placement of stent. Methods Eight patients with pancreatic pseudocyst were selected after abdominal ultrasonography and computed tomography. All patients have had be operated two times because of acute pancreatitis and /or cholangitis, and were hard to receive further operation. These patients underwent endoscopic transpapillary drainage by main pancreatic duct dilation or placement of stents after ERCP, and were follow up by abdominal ultrasonography and / or computed tomography 6 months after drainage. The stent would be pulled out after the complete disappearance of the cyst. Results Diagnostic ERCP revealed that cysts communicated with main pancreatic duct in 3 cases and obstructive jaundice was present in 1 case. All patients were managed by transpapillary main pancreatic duct dilation (3 cases) and placement of stents (5 cases). Both forms of endoscopic drainage were effective in treating pancreatic pseudocyst and in 7 cases the cysts were completely disappeared within 4 months, while the rest one required surgery as the cyst merely decreased in size. Only 2 cases the levels of amylase in serum and urine were higher than normal but no severe complications occurred. Conclusion Endoscopic transpapillary drainage through main pancreatic duct dilation or placement of stents is quietly an effective, painless and safe mode in treating pancreatic pseudo-cyst. This method may be an ideal choice for the treatment of pancreatic pseudocysts in experts.