Bhasin Deepak K, Rana Surinder S, Udawat Harsh P, Thapa Babu R, Sinha Saroj K, Nagi Birinder
Department of Gastroenterology, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Am J Gastroenterol. 2006 Aug;101(8):1780-6. doi: 10.1111/j.1572-0241.2006.00644.x. Epub 2006 Jun 16.
Endoscopic drainage of a single pseudocyst is a well-known treatment modality. Its role in the management of multiple pseudocysts is not well established. We evaluated the role of endoscopic transpapillary nasopancreatic drain (NPD) placement in the management of multiple and large pseudocysts.
Over 3 yr (2001-2004), endoscopic transpapillary NPD placement was attempted in 11 patients (age range 12-50 yr, 10 men) with symptomatic communicating multiple pseudocysts of pancreas (three in two and two in nine cases). A 5Fr/7Fr NPD was placed across the most distal duct disruption or into one of the pseudocysts.
Eight patients had an underlying chronic pancreatitis and three patients had pseudocysts as sequelae of acute pancreatitis. The size of pseudocysts ranged from 2 to 14 cm (mean 7.5 cm). Eight patients (72.7%) had at least one pseudocyst more than 6 cm in size. Nine patients had a partial disruption and two patients had complete disruption of the pancreatic duct. The NPD was successfully placed in 10 of 11 (90.9%) patients. Postprocedure acute febrile illness in one patient was the only complication noted, which responded to intravenous antibiotics. All pseudocysts resolved in 4-8 wk in 7 of 7 patients with successful bridging of the most distal ductal disruption. There was no recurrence of the pseudocysts in a mean follow-up of 19.4 months. Two patients, in whom there was a complete disruption and the NPD could not bridge the disruption, required surgery for the nonresolution of pseudocysts. In one patient with partial ductal disruption that could not be bridged, there was complete resolution of one pseudocyst and a decrease in the size of the other pseudocyst from 12 to 4 cm. The NPD was replaced by a stent and both the pseudocysts resolved in 20 wk.
Endoscopic transpapillary NPD placement is a safe and effective modality for the treatment of multiple and large pseudocysts, especially when there is partial ductal disruption, and the disruption can be bridged.
内镜下引流单个假性囊肿是一种广为人知的治疗方式。其在多发性假性囊肿治疗中的作用尚未明确。我们评估了内镜下经乳头鼻胰管引流（NPD）置入术在多发性和大型假性囊肿治疗中的作用。
在3年期间（2001 - 2004年），对11例有症状的胰腺交通性多发性假性囊肿患者（年龄范围12 - 50岁，男性10例）尝试进行内镜下经乳头NPD置入术（2例患者有3个假性囊肿，9例患者有2个假性囊肿）。将一根5Fr/7Fr的NPD穿过最远端的导管破裂处或置入其中一个假性囊肿内。
8例患者有潜在的慢性胰腺炎，3例患者的假性囊肿是急性胰腺炎的后遗症。假性囊肿大小为2至14厘米（平均7.5厘米）。8例患者（72.7%）至少有一个假性囊肿大小超过6厘米。9例患者的胰管部分破裂，2例患者胰管完全破裂。11例患者中有10例（90.9%）成功置入了NPD。唯一记录到的并发症是1例患者术后出现急性发热性疾病，经静脉使用抗生素后好转。7例成功桥接最远端导管破裂的患者中，所有假性囊肿在4 - 8周内消退。平均随访19.4个月，假性囊肿无复发。2例胰管完全破裂且NPD无法桥接破裂处的患者，因假性囊肿未消退而需要手术治疗。1例胰管部分破裂无法桥接的患者，其中一个假性囊肿完全消退，另一个假性囊肿大小从12厘米减小至4厘米。NPD被支架替代后，两个假性囊肿在20周内均消退。
内镜下经乳头NPD置入术是治疗多发性和大型假性囊肿的一种安全有效的方式，尤其是当存在部分导管破裂且破裂处可被桥接时。
