Kahaleh M, Shami V M, Conaway M R, Tokar J, Rockoff T, De La Rue S A, de Lange E, Bassignani M, Gay S, Adams R B, Yeaton P
Digestive Health Center, University of Virginia Health System, Charlottesville, Virgini 22908-0708, USA.
Endoscopy. 2006 Apr;38(4):355-9. doi: 10.1055/s-2006-925249.
Pancreatic pseudocysts are a complication in up to 20% of patients with pancreatitis. Endoscopic management of pseudocysts by a conventional transenteric technique, i. e. conventional transmural drainage (CTD), or by endoscopic ultrasound-guided drainage (EUD), is well described. Our aim was to prospectively compare the short-term and long-term results of CTD and EUD in the management of pseudocysts.
A total of 99 consecutive patients underwent endoscopic management of pancreatic pseudocysts according to this predetermined treatment algorithm: patients with bulging lesions without obvious portal hypertension underwent CTD; all remaining patients underwent EUD. Patients were followed prospectively, with cross-sectional imaging during clinic visits. We compared short-term and long-term results (effectiveness and complications) at 1 and 6 months post procedure.
46 patients (37 men) underwent EUD and 53 patients (39 men) had CTD. The mean age of the entire group was 50 +/- 13 years. There were no significant differences between the two groups regarding short-term success (93% vs. 94%) or long-term success (84% vs. 91%); 68 of the 99 patients completed 6 months of follow-up. Complications occurred in 19% of EUD vs. 18% of CTD patients, and consisted of bleeding in three, infection of the collection in eight, stent migration into the pseudocyst in three, and pneumoperitoneum in five. All complications but one could be managed conservatively.
No clear differences in efficacy or safety were observed between conventional and EUS-guided cystenterostomy. The choice of technique is likely best predicated by individual patient presentation and local expertise.
胰腺假性囊肿是高达20%的胰腺炎患者的一种并发症。通过传统经肠技术（即传统透壁引流术，CTD）或内镜超声引导下引流术（EUD）对假性囊肿进行内镜治疗已有详细描述。我们的目的是前瞻性比较CTD和EUD治疗假性囊肿的短期和长期结果。
根据这一预定治疗方案，共有99例连续患者接受了胰腺假性囊肿的内镜治疗：有突出病变且无明显门静脉高压的患者接受CTD；其余所有患者接受EUD。对患者进行前瞻性随访，在门诊就诊时进行横断面成像检查。我们比较了术后1个月和6个月时的短期和长期结果（有效性和并发症）。
46例患者（37例男性）接受了EUD，53例患者（39例男性）接受了CTD。整个组的平均年龄为50±13岁。两组在短期成功率（93%对94%）或长期成功率（84%对91%）方面无显著差异；99例患者中有68例完成了6个月的随访。EUD患者的并发症发生率为19%，CTD患者为18%，并发症包括3例出血、8例积液感染、3例支架移入假性囊肿和5例气腹。除1例并发症外，所有并发症均可保守处理。
传统囊肿胃吻合术与内镜超声引导下囊肿胃吻合术在疗效或安全性方面未观察到明显差异。技术的选择可能最好根据患者个体情况和当地专业知识来决定。
