超声内镜引导下金属支架引流与经皮肾镜清创治疗胰腺包裹性坏死的疗效比较  

Comparison of endoscopic ultrasound-guided drainage with metal stent and percutaneous nephroscopic necrosectomy for walled off necrosis

作　　者：赵丹琪 柴宁莉[1] 令狐恩强[1] 李隆松 张波[1] 徐宁 蔡守旺[2] 刘志伟[2] Zhao Danqi;Chai Ningli;Linghu Enqiang;Li Longsong;Zhang Bo;Xu Ning;Cai Shouwang;Liu Zhiwei(Department of Gastroenterology,The First Medical Center of PLA General Hospital,Beijing 100853,China;Department of Hepatobiliary and Pancreatic Surgery, The First Medical Center of PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心消化内科医学部,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：《中华腔镜外科杂志（电子版）》2021年第5期298-303,共6页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的比较超声内镜引导下金属支架引流与经皮肾镜清创治疗胰腺包裹性坏死(walled off necrosis,WON)的疗效,并探讨不同部位WON的最佳治疗模式。方法回顾性分析2018年10月至2020年12月于解放军总医院第一医学中心行超声内镜引导下金属支架引流治疗或行经皮肾镜清创治疗的WON患者临床资料,比较两组的治疗成功率、手术时间、并发症、住院时间、住院费用等。结果纳入的38例患者中13例为超声内镜组,WON位置均局限在胰腺或胰周;25例为经皮肾镜组,其中14例局限在胰腺或胰周。两组治疗成功率、并发症均差异无统计学意义。对于位置相同的WON,两组的治疗成功率、并发症差异无统计学意义;但超声内镜组的中位手术时间、住院时间、住院费用均小于经皮肾镜组[37.0 min(22.0~49.5 min)比90.0 min(52.5~135.0 min),P<0.001;8 d(6~12.5 d)比19 d(9~40 d),P=0.002;40550元(36734~67640元)比94151元(69813~251510元),P<0.001]。结论对于WON局限在胰腺或胰周的患者,适合行超声内镜下金属支架引流;当WON累及腹腔或盆腔时适合经皮肾镜清创治疗;若患者同时有多个不同部位的囊腔,可考虑超声内镜联合经皮肾镜清创治疗。Objective To compare the efficacy and safety of endoscopic ultrasound-guided(EUS-guided)drainage with metal stent and percutaneous nephroscopic necrosectomy in the treatment of walled off necrosis(WON),and to discuss the best treatment mode of WON at different sites.Methods The clinical datas of patients with WON who underwent EUS-guided drainage with metal stent or percutaneous nephroscopic necrosectomy in our hospital from Oct.2018 to Dec.2020 were retrospectively analyzed,and the treatment success rate,procedure duration,complications,hospital stay and cost et al between the two groups were compared.Results Thirteen of 38 patients included in the EUS group,and WON were confined to the pancreas or peripancreatic area.Of the 25 patients in the percutaneous nephroscopy group,14 patients had localized to pancreas or peripancreatic area.There was no statistical difference in treatment success rate and complication rate between the two groups.And there was no statistical difference in treatment success rate and complication rate between the two groups for the WON confined to pancreas or peripancreatic area.However,the median duration of procedure,median hospital stay and median cost in the EUS group was less than that in the percutaneous nephroscopy group[37.0 min(22.0-49.5 min)90.0 min(52.5-135.0 min),<0.00;8 d(6-12.5 d)19 d(9-40 d),0.002;40550 CNY[(36734-67640 CNY)94151 CNY(69813-251510 CNY),<0.001].Conclusions EUS-guided drainage with metal stent is suitable for patients with WON confined to pancreas or peripancreatic area and close to gastric wall.Percutaneous nephroscopic necrosectomy is more suitable for WON involving abdominal cavity and pelvic cavity and far from the gastric wall.If the patient has different sites of cysts at the same time,EUS-guided drainage combined with percutaneous nephroscopic necrosectomy can be considered.

关 键 词：胰腺包裹性坏死 金属支架 超声内镜 引流 经皮肾镜 

分 类 号：R73[医药卫生—肿瘤]