胰管支架移位合并急性胰腺炎10例临床分析及处理策略  

Clinical analysis and treatment strategy of ten cases of pancreatic duct stent displacement complicated with acute pancreatitis

作　　者：艾美娜[1] 高飞[1] 麻树人[1] 张迎春[1] 张宁[1] 王冰[2] 

机构地区：[1]沈阳军区总医院内窥镜科,110840 [2]沈阳军区总医院医务部,110840

出　　处：《中华消化杂志》2014年第11期748-751,共4页Chinese Journal of Digestion

基　　金：中国博士后科学基金（2012M521920）

摘　　要：目的 探讨胰管支架内移位合并急性胰腺炎的临床特征及处理策略.方法 回顾性分析10例胰管支架移位合并急性胰腺炎患者,所有病例均经实验室检查、X线透视、内镜及胰腺CT证实.术后观察患者临床症状,记录取出支架耗时,术前和术后第1、4、7天血清淀粉酶,总结其临床特点、移位时间、临床治愈时间和处理策略.结果 10例患者中男4例,女6例,平均年龄为55.9岁.移位的胰管支架均是带侧翼胰管支架,长度为5～7 cm,1例支架出现堵塞.2例胰管支架尾端位于胰颈部,7例位于胰头部,1例位于胰体部.临床症状为腹痛10例,恶心、呕吐7例,发热1例.胰管支架移位发生于术后平均2.9个月.所有移位支架均成功取出,其中利用取石球囊拖出胰管支架2例,活检钳夹出胰管支架7例,取石网篮取出支架1例,平均耗时为17.7 min.支架取出后1例再次植入胰管支架,余9例行鼻胰管外引流术.术后患者均未出现胰腺假性囊肿、胰腺脓肿、胰腺坏死、消化道出血等严重并发症.术后第1、4及7天血清淀粉酶平均值分别为508、137和86 U/L,平均恢复时间为6.7d,鼻胰管拨除时间平均为8.6d.结论 对于胰管支架内移位合并急性胰腺炎的患者,应尽快行经内镜逆行性胰胆管造影术取出支架及胰管引流术,该方法安全、有效,可短时间内改善症状.Objective To investigate clinical features and treatment strategy for pancreatic duct stent displacement complicated with acute pancreatitis.Methods Ten cases of pancreatic duct stent displacement complicated with acute pancreatitis were retrospectively analyzed.All the cases were confirmed by lab examination,X-ray examination,endoscopy and computed tomography （CT） examination.After operation,the clinical symptoms of patients were observed.Time consumed for stent removing and blood amylase level before endoscopic retrograde cholargio-pancreatography （ERCP） and 1st,4th,7th day after ERCP were recorded.Clinical features,the time of stent displacement,time of clinical cure and therapeutic strategy were summarized.Results The average age of the ten cases （four male and six female） was 55.9 years.All the displaced pancreatic duct stents were pancreatic duct stent with side wing,length five to seven cm.Obstruction was observed in one case.The end of the pancreatic duct stent of two cases dislocated at the neck of pancreats,seven cases at the head of pancreas and one at the body of pancreas.Ten cases presented with abdominal pain,seven with nausea and vomiting and one with fever.The average time of the occurrence of pancreatic duct stent displacement was 2.9 months.All the stents were successfully taken out,which of two cases were removed with balloon,seven cases with forcep and one with snare,and the average time duration was 17.7 min.After the stents taken out,pancreatic duct stent was replaced in one case and the left nine cases received nasal-pancreatic drainage treatment.After the operation,no severe complications such as pseudocyst of pancreas,pancreatic abscesses,pancreatic necrosis and gastrointestinal bleeding were observed in all the patients.Average blood amylase level at 1st,4th and 7th day after ERCP was 508 U/L,137 U/L and 86 U/L,respectively.The average time of recovery was 6.7 days,and the average time of keeping the nasal-pancreatic tube was 8.6 days.Conclusions For patients with pancreatic

关 键 词：胰管支架 移位 急性胰腺炎 

分 类 号：R657.5[医药卫生—外科学]