超声内镜引导下胰管引流的临床疗效分析(含视频)  

Therapeutic value of endoscopic ultrasound-guided pancreatic duct drainage(with video)

作　　者：沈珊珊[1] 聂双 李雯[1] 郑汝桦 蔡薇[1] 秦争艳[1] 张斌[1] 吕瑛[1] 邹晓平[1] 王雷[1] Shen Shanshan;Nie Shuang;Li Wen;Zheng Ruhua;Cai Wei;Qin Zhengyan;Zhang Bin;Lyu Ying;Zou Xiaoping;Wang Lei(Department of Gastroenterology,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School,Nanjing210008,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：《中华消化内镜杂志》2024年第11期889-894,共6页Chinese Journal of Digestive Endoscopy

基　　金：国家自然科学基金中德合作项目(M-0251);江苏省卫生健康委面上项目(M2021002);江苏省重大疾病生物资源样本库开放课题(SBK202001001);南京市卫生科技发展一般项目(YKK20055);南京鼓楼医院临床研究培育项目(2021-LCYJ-PY-26)。

摘　　要：目的探讨超声内镜引导下胰管引流术(endoscopic ultrasound-guided pancreatic duct drainage,EUS-PD)的有效性及安全性。方法回顾性分析南京大学医学院附属鼓楼医院2018年6月至2022年7月期间因内镜逆行胰管造影术(endoscopic retrograde pancreatography,ERP)失败、效果不佳或解剖结构改变无法行常规ERP治疗而接受EUS-PD的16例患者资料,分析EUS-PD治疗的完成情况(技术成功)、治疗效果(临床成功)以及不良事件发生情况。结果纳入的16例患者中,男14例、女2例,年龄(50.69±12.95)岁。共行19例次EUS-PD,其中3例次行辅助对接的ERP,15例次行EUS引导下胰管支架置入,1例次行EUS引导下鼻胰管置入术。19例次治疗中84.21%(16/19)实现技术成功,技术成功患者中93.75%(15/16)得到临床成功。术后总体不良事件发生率52.63%(10/19),腹痛47.37%(9/19),发热15.79%(3/19),术后胰腺炎15.79%(3/19)。不良反应均经保守后好转,无原发病或手术相关的死亡。中位随访17.6(8.2,22.3)个月,93.75%(15/16)的患者得到随访,成功行EUS-PD的患者中,76.92%(10/13)的患者未再发生腹痛症状。结论EUS-PD对于ERP失败、效果不佳或解剖结构改变的胰腺疾病是一种安全、有效的替代治疗方式。Objective To explore the effectiveness and safety of endoscopic ultrasound-guided pancreatic duct drainage(EUS-PD).Methods A retrospective analysis was conducted on data of 16 patients who underwent EUS-PD because of endoscopic retrograde pancreatography(ERP)failure,poor effectiveness or anatomical changes and couldn't undergo the routine ERP in Nanjing Drum Tower Hospital from June 2018 to July 2022.The technical success of EUS-PD,clinical efficacy and post-procedure adverse events were analyzed.Results In the 16 patients,there were 14 males and 2 females,with age of 50.69±12.95 years.A total of 19 times of EUS-PD operations were included,3 of them were rendezvous-assisted endoscopic retrograde pancreatography(RV-ERP),15 transgastric or transenteric EUS-guided stent placement and 1 was EUS-guided nasopancreatic duct placement.Technical success was achieved in 84.21%(16/19)patients,and among whom 93.75%(15/16)achieved clinical success.The overall incidence of postoperative adverse events was 52.63%(10/19)including 47.37%(9/19)abdominal pain,15.79%(3/19)fever and 15.79%(3/19)postoperative pancreatitis.All adverse effects were relieved after general conservative treatment and no primary disease or surgery-related death occurred.The mean follow-up was 17.6(8.2,22.3)months and 93.75%(15/16)of the patients were followed up.By the time of follow-up,76.92%(10/13)of the patients who had successfully received EUS-PD had no recurrence of abdominal pain or distension.Conclusion EUS-PD is a safe and effective alternative therapy for those with pancreatic diseases with ERP failure,poor efficacy or anatomical changes.

关 键 词：胰胆管造影术 内窥镜逆行 超声内镜 胰管引流 胰管支架 

分 类 号：R657.5[医药卫生—外科学]