在初始应用EUS引导一步术建立入路之后进行胰腺假性囊肿或脓肿的内镜下治疗  

Endoscopic management of pancreatic pseudocysts or Abscesses after an EUS-guided 1-step procedure for initial access

作　　者：Krüger M. Schneider A. S. Manns M. P. Meier P.N. 郝筱倩(译) 郑世成(校) 

机构地区：[1]Department of Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule Hannover, CarI-Neuberg-Str. 1, D-30625 Hannover, Germany [2]不详

出　　处：《世界核心医学期刊文摘（胃肠病学分册）》2006年第8期28-29,共2页Core Journals in Gastroenterology

摘　　要：Background: In this prospective case series, endoscopic management of pancreatic pseudocysts and Abscesses was investigated following an EUS-guided 1- step procedure for initial transmural access. Methods: Endoscopic drainage of pancreatic pseudocysts and Abscesses was performed in 35 patients (mean age, 51 years; range, 21- 81 years) by using interventional echoendoscopes (FG38UX and EG3830UT; Pentax-Hitachi, Lü bbecke, Germany). Interventions were performed by using a 1- step device consisting of a needle-wire suitable for cutting current, a 5.5F dilator, and an 8.5F plastic endoprosthesis (Giovannini Needle Wire Oasis, Cook Endoscopy,Winston-Salem, NC). Results: Endoscopic stent placement was successful in 33 of 35 patients (94% ), whereas repeated needle passages were unsuccessful in 2 cases (pancreatic pseudocystwall, 7 mm). No procedure-related complications, such as bleeding, perforation, or pneumoperitoneum, were observed. All subsequent complications, such as ineffective drainage (9% ), stent occlusion (12% ), or cyst infection (12% ), were managed endoscopically. Fourteen patients (43% ) demonstrated sustained clinical improvement and cyst resolutio upon placement of the initial 8.5F transmural drain. Ten patients (30% ) did not reveal a 50% reduction in cyst size on day 3, but cyst resolution was achieved by additional endoscopic cyst irrigation. Nine patients (27% ) with primary or secondary cyst infection underwent endoscopic balloon dilation and prolonged endoscopic drainage procedures to achieve cyst resolution. The overall resolution rate was 88% , with a recurrence rate of 12% , based on a mean follow-up period of 24 months. Conclusion: This 1- step EUS-guided technique with a needle-wire device provides safe transmural access and allows subsequent effective endoscopic management of pancreatic pseudocysts and Abscesses.Background： In this prospective case series, endoscopic management of pancreatic pseudocysts and abscesses was investigated following an EUS-guided 1 - step procedure for initial transmural access. Methods： Endoscopic drainage of pancreatic pseudocysts and abscesses was performed in 35 patients （mean age, 51 years; range, 21-81 years） by using interventional echoendoscopes （FG38UX and EG3830UT; Pentax-Hitachi, Lübbecke, Germany）. Interventions were performed by using a 1-step device consisting of a needle-wire suitable for cutting current, a 5.5F dilator, and an 8.5F plastic endoprosthesis （Giovannini Needle Wire Oasis, Cook Endoscopy, Winston-Salem, NC） . Results： Endoscopic stent placement was successful in 33 of 35 patients （94%）, whereas repeated needle passages were unsuccessful in 2 cases （pancreatic pseudocystwall, 7 mm）. No procedure-related complications, such as bleeding, perforation, or pneumoperitoneum, were observed. All subsequent complications, such as ineffective drainage （9%）, stent occlusion （12%）, or cyst infection （12%）, were managed endoscopically. Fourteen patients （43%） demonstrated sustained clinical improvement and cyst resolution upon placement of the initial 8.5F transmural drain. Ten patients （30%） did not reveal a 50% reduction in cyst size on day 3, but cyst resolution was achieved by additional endoscopic cyst irrigation. Nine patients （27%） with primary or secondary cyst infection underwent endoscopic balloon dilation and prolonged endoscopic drainage procedures to achieve cyst resolution. The overall resolution rate was 88%, with a recurrence rate of 12%, based on a mean follow-up period of 24 months.

关 键 词：超声内镜(EUS) 胰腺假性囊肿 内镜下治疗 脓肿 入路 引导 内镜下气囊扩张 介入操作 支架放置术 相关并发症 

分 类 号：R445[医药卫生—影像医学与核医学] R657.52[医药卫生—诊断学]