Boerma D, Rauws E A, van Gulik T M, Huibregtse K, Obertop H, Gouma D J
Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
Br J Surg. 2000 Nov;87(11):1506-9. doi: 10.1046/j.1365-2168.2000.01573.x.
Spontaneous closure of an external pancreatic fistula is unlikely when a concomitant downstream obstruction of the pancreatic duct inhibits downstream flow. Early endoscopic retrograde pancreatography (ERP) and stent insertion may enhance fistula closure in these patients.
The results of endoscopic stenting of the pancreatic duct were evaluated in 15 patients with an external pancreatic fistula that developed after operative necrosectomy and debridement of the pancreas (seven men and eight women, median age 45 (range 25-68) years).
Median drainage before ERP was 50-800 ml/day, with an amylase content of 210,00-493,000 units/l. ERP was performed after a median time of 35 days and revealed leakage of the duct and a downstream obstruction in all patients. An endoprosthesis was inserted beyond the site of obstruction. Within a median time of 10 (range 2-64) days drainage stopped in all patients. In one patient ERP failed and pancreaticojejunostomy was performed. During follow-up (median 24 (range 2-55) months) three patients required resection of the pancreatic tail because of pseudocyst formation, all of whom originally had leakage from the tail area.
Based on these data, an active approach for external pancreatic fistula seems warranted. Early ERP and stent insertion enhances fistula resolution, facilitates wound care and surgery is postponed or even avoided.
当胰管下游存在梗阻导致下游液体流动受阻时，胰外瘘自发闭合的可能性较小。早期内镜逆行胰胆管造影（ERP）及支架置入术可能会促进这类患者的瘘口闭合。
对15例在胰腺手术清创及坏死组织清除术后发生胰外瘘的患者（7例男性，8例女性，中位年龄45岁（范围25 - 68岁））进行胰管内镜支架置入术的效果评估。
ERP术前中位引流量为50 - 800毫升/天，淀粉酶含量为210,00 - 493,000单位/升。ERP在中位时间35天后进行，结果显示所有患者均存在胰管渗漏及下游梗阻。在梗阻部位远端置入了内支架。所有患者在中位时间10天（范围2 - 64天）内引流量停止。1例患者ERP失败，改行胰空肠吻合术。在随访期间（中位时间24个月（范围2 - 55个月）），3例患者因假性囊肿形成需要切除胰尾，所有这些患者最初均为胰尾区域渗漏。
基于这些数据，对于胰外瘘采取积极的治疗方法似乎是合理的。早期ERP及支架置入可提高瘘口愈合率，便于伤口处理，从而推迟甚至避免手术。
