Bhasin Deepak Kumar, Rana Surinder Singh, Siyad Ismail, Poddar Ujjal, Thapa Babu Ram, Sinha Saroj Kant, Nagi Birinder
Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160023, India.
J Gastroenterol Hepatol. 2006 Jun;21(6):1059-64. doi: 10.1111/j.1440-1746.2005.04049.x.
Pancreatic ascites and pleural effusion are uncommon sequelae of pancreatitis and are associated with significant morbidity and mortality. Endoscopic decompression of the pancreatic duct through transpapillary stent or nasopancreatic drain (NPD) has shown encouraging results but the experience is limited. The aim of the present study was to evaluate the efficacy of endoscopic transpapillary nasopancreatic drainage in patients with pancreatic ascites and pleural effusion.
Over a period of 9 years, 10 patients (eight male) with pancreatic ascites and/or pleural effusion with pancreatic duct disruption documented on pancreatogram were studied. After informed consent, endoscopic transpapillary NPD was placed. The end-points were resolution of ascites and/or pleural effusion or need for surgery.
Of 10 patients (age range: 13 months-46 years), four patients had only ascites, four had only pleural effusion and two had both ascites and pleural effusion. Ascites and/or pleural effusion resolved in all the patients within 4 weeks of placement of NPD. The healing of ductal disruption was demonstrated by nasopancreatogram as early as 2 weeks and NPD could be removed without necessitating another endoscopy. No major complications related to NPD placement were noted. There was no recurrence of pancreatic ascites and/or pleural effusion at a mean follow up of 39 months.
Pancreatic ascites and pleural effusion can be effectively treated by endoscopic retrograde pancreatography and transpapillary NPD placement.
胰源性腹水和胸腔积液是胰腺炎不常见的后遗症，与显著的发病率和死亡率相关。通过经乳头支架或鼻胰管引流（NPD）进行胰管内镜减压已显示出令人鼓舞的结果，但经验有限。本研究的目的是评估内镜下经乳头鼻胰管引流术对胰源性腹水和胸腔积液患者的疗效。
在9年的时间里，对10例（8例男性）经胰管造影证实有胰管破裂的胰源性腹水和/或胸腔积液患者进行了研究。在获得知情同意后，放置内镜下经乳头鼻胰管引流管。观察终点为腹水和/或胸腔积液的消退或手术需求。
10例患者（年龄范围：13个月至46岁）中，4例仅有腹水，4例仅有胸腔积液，2例既有腹水又有胸腔积液。在放置鼻胰管引流管后的4周内，所有患者的腹水和/或胸腔积液均消退。鼻胰管造影最早在2周时显示胰管破裂愈合，无需再次内镜检查即可拔除鼻胰管引流管。未发现与放置鼻胰管引流管相关的严重并发症。平均随访39个月时，胰源性腹水和/或胸腔积液无复发。
胰源性腹水和胸腔积液可通过内镜逆行胰胆管造影术和经乳头放置鼻胰管引流管有效治疗。
