内镜下覆膜金属支架置入引流治疗胰腺坏死感染和假性囊肿13例及文献分析  

Endoscopic ultrasound-guided drainage using lumen-apposing fully covered,selfexpandable metal stent for treatment of infected pancreatic necrosis and pseudocyst:analysis of 13 cases and literature review

作　　者：杨歆 孙玲 黄其密 刘璐 樊超强 李春花 林辉 任成山 柏健鹰 杨仕明 YANG Xin;SUN Ling;HUANG Qimi;LIU Lu;FAN Chaoqiang;LI Chunhua;LIN Hui;REN Chengshan;BAI Jianying;YANG Shiming(Department of Gastroenterology,Second Affiliated Hospital,Army Medical University (Third Military Medical University),Chongqing,400037,China)

机构地区：[1]陆军军医大学(第三军医大学)第二附属医院消化内科,重庆400037

出　　处：《第三军医大学学报》2019年第2期137-142,共6页Journal of Third Military Medical University

基　　金：第三军医大学新桥医院临床科研项目(2014YLC15)~~

摘　　要：目的探讨内镜下覆膜金属支架置入引流治疗胰腺坏死感染(infected pancreatic necrosis,IPN)和胰腺假性囊肿(pancreatic pseudocyst,PPC)的有效性、可行性和安全性。方法选取2012-2017年我科收治的IPN、PPC并进行覆膜金属支架置入引流治疗的13例患者。计算机检索同期中国知网、万方数据库、维普网、Cochrane Library、PubMed、Web of Science等数据库收录的公开发表的内镜下覆膜金属支架置入引流治疗IPN和PPC患者文献数据,最终选取12篇文献,纳入IPN 193例,PPC138例,对覆膜金属支架置入引流治疗IPN和PPC的疗效进行分析。结果我科13例患者(IPN 12例,PPC 1例)支架置入成功率100%(13/13),救治成功率92.3%(12/13),1例(7.7%)患者因感染严重及脓腔出血死亡;未发生支架移位、脓(囊)腔破裂穿孔、堵管,术后并发肺部感染者6例(46.2%),平均住院时间为44.8(9～153) d。12篇文献共纳入331例患者(193例IPN、138例PPC),救治成功率98.5%(326/331),死亡率1.5%(5/331)。本研究和文献报道共计344例(206例IPN,138例PPC)患者,手术成功率100%(344/344),救治成功率98.3%(338/344),死亡率1.7%(6/344);发生支架移位13例(3.8%),术后出血11例(3.2%),堵管3例(0.9%),穿孔1例(0.3%),伴肺部感染及泌尿系感染19例(5.5%)。结论内镜下覆膜金属支架置入引流治疗IPN和PPC手术成功率较高,临床疗效较好,并发症少,死亡率低。Objective To investigate the feasibility,efficacy and safety of endoscopic ultrasound(EUS)-guided drainage of peripancreatic fluid collection(PFC) using lumen-apposing fully covered,selfexpandable metal stent(LAMS) for treatment of infected pancreatic necrosis(IPN) and pancreatic pseudocyst(PPC).Methods We retrospectively analyzed the data of 13 patients(including 11 male and 2 female patients,mean age 42.6±12.1 years) with IPN(12 cases) or PPC(1 case) treated with EUS-guided drainage of PFC using LAMS in our department from January,2012 to December,2017.We also searched China National Knowledge Infrastructure(CNKI),Wanfang Database,VIP Database Network,Cochrane Library,Pubmed,and Web of Science for relevant studies to analyze the efficacy and safety of LAMS in the treatment of IPN and PPC.Results Stent placement was successful in all the 13 patients treated in our department.Twelve(92.3%) of the patients were cured,and 1(7.7%) died for severe infection and intraabscess hemorrhage.None of the patients experienced stent displacement,abscess or cyst cavity rupture(or perforation),or drainage tube occlusion.Six(46.2%) of the patients had pulmonary infections after the operation.The mean length of hospital stay of the patients was 44.8 d(range 9-153 d).We retrieved 12 relevant studies from the databases involving a total of 331 patients(193 with IPN and 138 with PPC),among whom 326(98.5%) were successfully treated and 5(1.5%) died.In the total of 344 cases after combining our cases with the reported cases(including 206 patients with IPN and 138 with PPC),the success rate of LAMS surgery was 100%,the cure rate was 98.3%(338 cases),and the mortality rate was 1.7%(6 cases);stent displacement occurred in 13 cases(3.8%),postoperative bleeding in 11 cases(3.2%),stent occlusion in 3 cases(0.9%),postoperative abscess perforation in 1 case(0.3%),and postoperative with lung and urinary tract infections in 19 cases(5.5%).Conclusion EUS-guided drainage of PFC using LAMS has a high success rate for treatment of IPN and PPC and a

关 键 词：胰腺坏死感染 胰腺假性囊肿 超声内镜 覆膜金属支架 清创引流 

分 类 号：R181.23[医药卫生—流行病学]