Varadarajulu Shyam, Noone Tara C, Tutuian Radu, Hawes Robert H, Cotton Peter B
Digestive Disease Center, Department of Radiology, Medical University of South Carolina, Charleston, SC, USA.
Gastrointest Endosc. 2005 Apr;61(4):568-75. doi: 10.1016/s0016-5107(04)02832-9.
The aim of this study was to identify predictors of outcome for pancreatic duct (PD) disruption managed by endoscopic transpapillary stent insertion.
An endoscopy database was used to identify patients with PD disruption, defined as extravasation of contrast from the PD during ERCP. Data collected included demographic information, the results of imaging studies, management before endoscopic intervention, and outcomes after stent placement. Stents typically were exchanged at intervals of 6 to 8 weeks. Success was defined as clinical and pancreatographic resolution of the PD disruption.
Ninety-seven consecutive patients (34 women, 63 men; mean age, 53.7 [12.3] years) with PD disruption seen from 1995 to 2002 were identified. Causes of the disruption were the following: chronic pancreatitis (47), acute pancreatitis (44), operative injury (4), and trauma (2). Transpapillary PD stent insertion was technically successful in 92 (95%) patients; two underwent a combined cystenterostomy. The median duration of stent placement was 58 days (range 4-640 days). The outcome of stent insertion was successful in 52 patients (55%), unsuccessful in 32 (36%), and indeterminate in 8 (9%). On univariate analysis, a partially disrupted PD (p < 0.001), a disruption in the body of the pancreas (p = 0.04), a stent positioned to bridge the disruption (p < 0.001), and a longer duration of stent therapy (p = 0.03) were associated with a successful outcome. On multivariable logistic regression, only a partially disrupted duct and a stent bridging the disruption correlated with a successful outcome. Complications occurred in 6 patients.
Successful resolution of PD disruption by transpapillary stent insertion depends on the type of disruption and the ability to bridge the disrupted duct with a stent.
本研究的目的是确定经内镜乳头支架置入术治疗胰管（PD）破裂的预后预测因素。
使用内镜数据库识别PD破裂患者，定义为内镜逆行胰胆管造影（ERCP）期间造影剂从PD外渗。收集的数据包括人口统计学信息、影像学检查结果、内镜干预前的治疗情况以及支架置入后的结局。支架通常每6至8周更换一次。成功定义为PD破裂的临床和胰管造影表现消失。
确定了1995年至2002年间连续97例PD破裂患者（34例女性，63例男性；平均年龄53.7 [12.3]岁）。破裂原因如下：慢性胰腺炎（47例）、急性胰腺炎（44例）、手术损伤（4例）和外伤（2例）。经乳头PD支架置入术在92例（95%）患者中技术成功；2例患者接受了联合囊肿肠吻合术。支架置入的中位持续时间为58天（范围4至640天）。支架置入的结局在52例患者（55%）中成功，32例（36%）中失败，8例（9%）中不确定。单因素分析显示，部分破裂的PD（p < 0.001）、胰腺体部破裂（p = 0.04）、用于跨越破裂处的支架（p < 0.001）以及较长的支架治疗持续时间（p = 0.03）与成功结局相关。多变量逻辑回归分析显示，只有部分破裂的导管和跨越破裂处的支架与成功结局相关。6例患者出现并发症。
经乳头支架置入术成功解决PD破裂取决于破裂类型以及用支架跨越破裂导管的能力。
