超声内镜引导下双蘑菇头金属支架早期拔除治疗胰腺包裹性坏死的疗效及预后分析  

Efficacy and outcomes analysis of endoscopic ultrasound-guided early removal of lumen-apposing metal stent in the treatment of pancreatic walled-off necrosis

作　　者：吴松婷 窦晓坛 李娜[1] 许赛飞 朱浩[1] 王雷[1] 于成功[1] 刘明东[1] Wu Songting;Dou Xiaotan;Li Na;Xu Saifei;Zhu Hao;Wang Lei;Yu Chenggong;Liu Mingdong(Department of Gastroenterology,Nanjing Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院消化内科,南京210008

出　　处：《中华胰腺病杂志》2024年第5期332-337,共6页Chinese Journal of Pancreatology

摘　　要：目的评价双蘑菇头金属支架(LAMS)早期拔除对治疗胰腺包裹性坏死(WON)疗效及预后的影响。方法回顾性分析2018年1月至2022年12月间南京鼓楼医院使用LAMS行超声内镜(EUS)引导下穿刺引流术(ETD)和内镜下坏死清创术(DEN)的51例WON患者。根据LAMS拔除时间分为早期拔除组(≤2周,24例)和传统拔除组(>2周,27例),比较两组患者WON治疗的近期疗效、安全性及远期预后情况。结果51例患者LAMS置入成功率达100%,所有患者ETD术后均接受DEN治疗,其中早期拔除组中位清创次数低于传统拔除组(2.0次比3.0次),差异有统计学意义(P<0.05),术后再次接受经皮穿刺置管引流(PCD)及外科手术的患者分别有15.7%和5.9%,两组差异无统计学意义。早期拔除组临床成功率及死亡率分别为79.2%和8.3%,与传统拔除组(81.5%、3.7%)相比,差异无统计学意义。从安全性来看,早期拔除组支架留置期间不良事件发生率明显低于传统拔除组(12.5%、37.0%),差异有统计学意义(P<0.05)。46例患者累计随访6个月,早期拔除组的WON复发率、内镜再干预率及远期并发症发生率分别为20.0%、10.0%和20.0%,较传统拔除组(7.7%、3.8%、38.5%)未见明显上升趋势,差异无统计学意义。结论在治疗WON时LAMS的早期拔除在一定程度上是安全有效的,相较于2周后拔除的传统做法,早期拔除LAMS并没有降低临床成功率,亦没有增加疾病死亡率、复发率及远期并发症的发生率,反而降低了支架留置期间不良事件的发生率,并且减少了后续清创次数。ObjectiveTo evaluate the efficacy and outcomes of early removal of lumen-apposing metal stent(LAMS)in the treatment of pancreatic wall-off necrosis(WON).MethodsA retrospective analysis was performed on 51 patients with WON who underwent endoscopic ultrasound(EUS)-guided transluminal drainage(ETD)and direct endoscopic necrosectomy(DEN)using LAMS at Nanjing Drum Tower Hospital from January 2018 to December 2022.Patients were divided into the early removal group(within two weeks,n=24)and the traditional removal group(after two weeks,n=27)based on the timing of LAMS removal.The short-term effects,safety and long-term outcomes of WON were compared between the two groups.ResultsThe technical success rate of LAMS placement in 51 patients reached 100%,and all patients underwent ETD and DEN.The median number of necrosectomy sessions in the early removal group was significantly lower than in the traditional removal group,2.0 sessions vs 3.0 sessions and the difference was statistically significant(P<0.05).Postoperatively,15.7%of patients required percutaneous catheter drainage(PCD)and 5.9%required surgery,with no significant difference between the two groups.The clinical success rate and mortality rate in the early removal group were 79.2%and 8.3%,respectively,compared to 81.5%and 3.7%in the traditional removal group,with no statistically significant difference.In terms of safety,the early removal group exhibited a significantly lower rate of adverse events during stent retention with statistically significant difference(12.5%vs 37.0%,P<0.05)compared to the traditional removal group.A total of 46 patients were followed up for six months.In the early removal group,the rates of disease recurrence,need for endoscopic reintervention and occurrence of long-term complications were 20.0%,10.0%and 20.0%,respectively.These rates did not show a significant increase compared to the traditional removal group,which were 7.7%,3.8%and 38.5%,respectively,without significant differences between the groups.ConclusionsIn the treatment of WON

关 键 词：胰腺包裹性坏死 双蘑菇头金属支架 早期拔除 不良事件 超声内镜引导下穿刺引流术 

分 类 号：R657.5[医药卫生—外科学]