Seewald Stefan, Brand Boris, Groth Stefan, Omar Salem, Mendoza Gerardo, Seitz Uwe, Yasuda Ichiro, Xikun He, Nam Vo Chieu, Xu Hong, Thonke Frank, Soehendra Nib
Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Gastrointest Endosc. 2004 Apr;59(4):463-70. doi: 10.1016/s0016-5107(03)02708-1.
The treatment of pancreatic fistula can be difficult. A novel endoscopic approach to sealing pancreatic fistulas by using N-butyl-2-cyanoacrylate is described.
Twelve patients with pancreatic fistulas underwent endoscopic injection of N-butyl-2-cyanoacrylate into the fistulous tract, in addition to endoscopic drainage.
Fistulas were closed successfully in 8 of 12 patients. A single treatment session was successful in 7 patients; a second session was required in one patient. In two patients, closure was temporary, and, in one patient, the treatment failed. One patient died 24 hours after treatment. He developed a pulmonary thromboembolism from a left popliteal vein thrombosis and died from complications of surgical thromboembolectomy. At autopsy, a pulmonary embolus was found, but there was no evidence of N-butyl-2-cyanoacrylate in the lungs. No procedure-related complication occurred over a median follow-up of 20.7 months (range 9-51 months).
In this preliminary study, occlusion of pancreatic fistulas by using N-butyl-2-cyanoacrylate glue was safe and effective, and obviated the need for surgery in a substantial proportion of patients. Further studies of the use of N-butyl-2-cyanoacrylate for closure of pancreatic fistula are warranted.
胰瘘的治疗可能具有挑战性。本文描述了一种使用N-丁基-2-氰基丙烯酸酯封闭胰瘘的新型内镜治疗方法。
12例胰瘘患者除接受内镜引流外，还接受了将N-丁基-2-氰基丙烯酸酯内镜注射到瘘管中的治疗。
12例患者中有8例瘘管成功闭合。7例患者单次治疗成功；1例患者需要进行第二次治疗。2例患者的闭合是暂时的，1例患者治疗失败。1例患者在治疗后24小时死亡。他因左腘静脉血栓形成并发肺血栓栓塞，并死于手术取栓的并发症。尸检时发现有肺栓塞，但肺部没有N-丁基-2-氰基丙烯酸酯的证据。在中位随访20.7个月（范围9 - 51个月）期间未发生与手术相关的并发症。
在这项初步研究中，使用N-丁基-2-氰基丙烯酸酯胶水封闭胰瘘是安全有效的，并且在相当一部分患者中避免了手术的需要。有必要对使用N-丁基-2-氰基丙烯酸酯封闭胰瘘进行进一步研究。
