CAJ | 학술논문

目的评价超声内镜(EUS)引导下胰腺假性囊肿(PPC)引流术的安全性和有效性.方法 17例PPC患者行EUS以探查和确定适当的穿刺点及穿刺深度,经内镜活检孔将穿刺针刺入PPC腔内,用注射器抽出囊液,X线引导下沿针孔插入导丝,沿导丝置入针状刀以切开胃壁和囊壁,行球囊扩张,根据囊液性状选择引流方式.评价操作成功率、治疗成功率、并发症发生率和操作技巧.结果 4例行鼻囊肿管外引流,9例行双猪尾支架内引流,4例行鼻囊肿管和双猪尾支架联合引流,其治疗成功率分别为3/4、7/9、4/4.1例患者于支架放置成功后见穿刺部位渗血,因内镜下治疗等措施无效而转行外科手术缝扎止血.4例患者在PPC引流过程中出现感染,其中2例因内科治疗效果不佳转行外科手术切除,另2例经静脉滴注囊液细菌敏感抗生素和经鼻囊肿管甲硝唑溶液冲洗PPC处理后痊愈.中位随访时间为28.5个月,无1例复发.结论 EUS引导下PPC引流术安全有效,支架和鼻囊肿管引流对PPC治疗具有重要价值.
목적 평개초성내경(EUS)인도하이선가성낭종(PPC)인류술적안전성화유효성.방법 17례PPC환자행EUS이탐사화학정괄당적천자점급천자심도,경내경활검공장천자침자입PPC강내,용주사기추출낭액,X선인도하연침공삽입도사,연도사치입침상도이절개위벽화낭벽,행구낭확장,근거낭액성상선택인류방식.평개조작성공솔、치료성공솔、병발증발생솔화조작기교.결과 4례행비낭종관외인류,9례행쌍저미지가내인류,4례행비낭종관화쌍저미지가연합인류,기치료성공솔분별위3/4、7/9、4/4.1례환자우지가방치성공후견천자부위삼혈,인내경하치료등조시무효이전행외과수술봉찰지혈.4례환자재PPC인류과정중출현감염,기중2례인내과치료효과불가전행외과수술절제,령2례경정맥적주낭액세균민감항생소화경비낭종관갑초서용액충세PPC처리후전유.중위수방시간위28.5개월,무1례복발.결론 EUS인도하PPC인류술안전유효,지가화비낭종관인류대PPC치료구유중요개치.
Objective To assess the safety and the efficacy of endoscopic ultrasound (EUS)-guided transmural drainage of pancreatic pseudocysts (PPC).Methods A total of 17 patients with PPC who underwent EUS to detect the optimal site and depth of puncture.The needle was punctured into the PPC cavity through endoscopic biopsy hole,cyst fluid was drained with a syringe.The guide wire was inserted along the pinhole under X-ray,and then the needle-knife was sent along the guide wire to cut the gastric wall and pseudocysts wall,followed by balloon dilation.The way of drainage was selected according to the cyst fluid properties.The technical success rate,treatment success rate,complication occurring rate and the skills were evaluated.Results Four patients were with nasalcystic catheter drainage,9 patients with double pigtail stents internal drainage,and 4 patients with nasal-cystic catheter and double pigtail stents combination drainage.The treatment success rates were 3/4,7/9,and 4/4 respectively.Only 1 patient subsequently developed bleeding from puncture site after stent successively placed,and was turned to surgery because of ineffective endoscopic treatment.Infection occurred in 4 patients during drainage,two of those were switched to surgical resection due to poor medical treatment response,and the other 2 were cured with intravenous infusion of antibiotics sensitive to cyst fluid bacteria and metronidazole rinse PPC.The median follow-up duration was 28.5months,and there was none of recurrence.Conclusions EUS-guided transmural drainage of PPC is safe.Stent placement and nasal-cystic catheter play an important role in PPC treatment.