Bartoli Eric, Delcenserie Richard, Yzet Thierry, Brazier Franck, Geslin Guillaume, Regimbeau Jean-Marc, Dupas Jean-Louis
Service d'Hépato-Gastroentérologie, CHU Hôpital Nord, Amiens.
Gastroenterol Clin Biol. 2005 May;29(5):515-21. doi: 10.1016/s0399-8320(05)82122-0.
Endoscopy offers an alternative to surgery for the treatment of ductal complications in patients with chronic pancreatitis. The aim of this study was to evaluate the efficacy of endoscopic treatment on pain, cholestasis and pseudocysts in these patients.
Thirty-nine patients (37 M, 2 F, mean age 44), were included in the study. All patients had at least one of the following criteria demonstrated by imaging tests: dilatation of the main pancreatic duct (MPD) with or without stricture (N = 13), bile duct stricture (N = 12), or pancreatic pseudocyst (N = 14) with pancreatic duct stricture (N = 11) or biliary stricture (N = 3). Pancreatic or biliary sphincterotomy, insertion of pancreatic or biliary stent, pseudocyst drainage with stent placement were performed according to ductal abnormalities. Patients were evaluated early and followed up during the stenting period, and after stent removal.
Patients underwent a median of 3.5 endoscopic procedures with an interval of 2.2 months between 2 stenting sessions. A pancreatic or biliary stent was inserted in 25 patients with ductal abnormalities and in 11 patients with pseudocysts. Endoscopic pseudocyst drainage was performed in 6 cases. The mean stenting time was 6 months (range: 3-21). Mean follow-up after stent removal was 9.7 (2-48) months. Complications of endoscopic treatment were encountered in 7% of patients with no deaths. Pain relief was achieved after the first endoscopic procedure and during the overall stenting period in all patients. Recurrence of pain was observed after stent removal in 5/11 patients, requiring surgery in 4. Cholestasis decreased and biochemical values normalized within one month after biliary stenting. Recurrence of cholestasis was observed early after stent removal in 4/9 patients who required complementary surgical treatment. No recurrence of pancreatic pseudocyst was observed after endoscopic drainage and stent removal during the follow-up period.
Endoscopic treatment of pain from pancreatic pseudocysts or ductal strictures is effective in the short-term and in the period of ductal stenting. However, the optimal duration of the latter remains to be determined.
对于慢性胰腺炎患者，内镜检查为导管并发症的治疗提供了一种手术替代方案。本研究旨在评估内镜治疗对这些患者疼痛、胆汁淤积及假性囊肿的疗效。
39例患者（37例男性，2例女性，平均年龄44岁）纳入本研究。所有患者经影像学检查至少符合以下标准之一：主胰管扩张伴或不伴狭窄（n = 13）、胆管狭窄（n = 12）、或胰腺假性囊肿（n = 14）伴胰腺导管狭窄（n = 11）或胆管狭窄（n = 3）。根据导管异常情况进行胰或胆管括约肌切开术、胰或胆管支架置入、带支架置入的假性囊肿引流。对患者进行早期评估，并在支架置入期间及支架取出后进行随访。
患者平均接受3.5次内镜手术，两次支架置入间隔时间为2.2个月。25例有导管异常的患者和11例有假性囊肿的患者置入了胰或胆管支架。6例患者进行了内镜下假性囊肿引流。平均支架置入时间为6个月（范围：3 - 21个月）。支架取出后的平均随访时间为9.7（2 - 48）个月。7%的患者出现内镜治疗并发症，无死亡病例。所有患者在首次内镜手术后及整个支架置入期间疼痛均得到缓解。11例患者中有5例在支架取出后出现疼痛复发，其中4例需要手术治疗。胆管支架置入后1个月内胆汁淤积减轻，生化指标恢复正常。9例患者中有4例在支架取出后早期出现胆汁淤积复发，需要辅助手术治疗。随访期间，内镜引流及支架取出后未观察到胰腺假性囊肿复发。
内镜治疗胰腺假性囊肿或导管狭窄引起的疼痛在短期及导管支架置入期是有效的。然而，后者的最佳持续时间仍有待确定。
