经窦道胃支架管置入引流术在持续性胰外瘘患者中的临床应用分析  

Trans gastric sinus stent placement and drainage in management of persistent external pancreatic fistula

作　　者：陈玉辉 刘志伟[2] 王鹏飞[2] 辛宪磊[2] 任为正[2] 陈继业[2] 蔡守旺[2] Chen Yuhui;Liu Zhiwei;Wang Pengfei;Xin Xianlei;Ren Weizheng;Chen Jiye;Cai Shouwang(Department of General Surgery,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Department of Hepatobiliary and Pancreatic Surgery,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心普通外科医学部,北京100853 [2]解放军总医院第一医学中心肝胆胰外科医学部,北京100853

出　　处：《中华肝胆外科杂志》2021年第9期681-684,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨经窦道胃支架管置入引流术在治疗持续性胰外瘘中的临床价值。方法回顾分析2018年8月至2020年12月在解放军总医院第一医学中心治疗的12例因重症急性胰腺炎、胰腺外伤或胰腺手术导致持续性胰外瘘患者临床资料,其中男性10例,女性2例,年龄范围30~65岁,中位年龄43.5岁。所有患者均行经窦道胃支架管置入引流术。术后通过门诊复查随访胰瘘复发、新的胰液积聚、并发症和死亡情况。结果重症急性胰腺炎致持续性胰外瘘9例,胰腺外伤致持续性胰外瘘2例,胰腺手术致持续性胰外瘘1例。手术操作时间38~54 min,中位数47 min,均为操作1次成功,置管技术成功率100.0%(12/12)。随访2~29个月,中位数22.5个月。手术后7 d内,所有患者均拔除经皮引流管。1例(8.3%)术后17 d胰瘘复发,考虑支架管堵塞,采用相同方法再次放置支架管后痊愈。术后6个月复查2例(16.7%)支架管脱落,其中1例再次出现假性囊肿(胰瘘复发),观察9个月胰腺假性囊肿逐渐增大至最大径7 cm时,在内镜下放置双猪尾巴引流管痊愈。另1例患者无胰瘘复发或假性囊肿。随访期间,无患者出现新的胰液积聚、发热、出血、感染、器官功能损伤等并发症,无患者死亡。结论经窦道胃支架管置入引流术治疗持续性胰外瘘技术简单、安全、效果好。但长期疗效尚有待进一步观察。Objective To study the use of trans gastric sinus stent placement and drainage in management of persistent external pancreatic fistula.Methods The clinical data of 12 patients who developed persistent external pancreatic fistulae after severe acute pancreatitis,pancreatic trauma or pancreatic surgery who were treated at the First Medical Center of Chinese PLA General Hospital from August 2018 to December 2020 were retrospectively analyzed.There were 10 males and 2 females,aged 30 to 65 years,median 43.5 years.These patients underwent trans gastric sinus stent placement and drainage,and were followed-up to study persistence of pancreatic fistula,new pancreatic fluid accumulation,complications and death.Results In this study,there were 9 patients who developed persistent external pancreatic fistulae after severe acute pancreatitis,2 patients after pancreatic trauma,and 1 patient after pancreatic surgery.The median operation time was 47 min(range 38-54 min).The technical success rate was 100.0%(12/12).The median follow-up was 22.5 months(range 2-29 months).Seven days after stenting,the percutaneous drainage tubes(urinary catheters)of all the patients were removed.One patient(8.3%)developed recurrence of pancreatic fistula 17 days after treatment.The same procedure of placing another stent was done and the patient recovered.Six months after treatment,2 patients(16.7%)lost their stents,and 1 patient developed a pseudocyst(recurrence of pancreatic fistula).The maximum diameter of this pseudocyst increased gradually to 7cm after 9 months.A double pigtail drainage tube was placed under endoscopy in this patient,and the patients recovered.All the other patients did not develop recurrence of pancreatic fistula or pseudocyst.During the follow-up period,no patient developed any new complications including pancreatic fluid accumulation,fever,bleeding,infection and organ dysfunction,and no patients died.Conclusion It was safe and efficacious to use trans gastric sinus stent placement for treatment of persistent external pancre

关 键 词：最小侵入性外科手术 放射学介入 内镜检查 胰瘘 

分 类 号：R657.5[医药卫生—外科学]