重症慢性胰腺炎胰管支架置入术后的长期预后

Long-term outcome after pancreatic stenting in severe chronic pancreatitis.

作者信息

Eleftherladis N, Dinu F, Delhaye M, Le Moine O, Baize M, Vandermeeren A, Hookey L, Devière J

机构信息

Department of Gastroenterology, Université Libre de Bruxelles, Hôpital Erasme, Brussels, Belgium.

出版信息

Endoscopy. 2005 Mar;37(3):223-30. doi: 10.1055/s-2005-860988.

DOI:10.1055/s-2005-860988

PMID:18556820

Abstract

BACKGROUND AND STUDY AIMS

Although it has been proved that pancreatic stenting is effective in the symptomatic management of severe chronic pancreatitis, long-term outcomes after stent removal have not been fully evaluated.

PATIENTS AND METHODS

A total of 100 patients (75 men, 25 women; median age 49) with severe chronic pancreatitis and pancreatic duct strictures were successfully treated for pancreatic pain using polyethylene pancreatic stents and were followed up for at least 1 year after stent removal. The stents were exchanged "on demand" (in cases of recurrence of pain) and a definitive stent removal was attempted on the basis of clinical and endoscopic findings. Clinical variables were retrospectively assessed as potential predictors of re-stenting.

RESULTS

The etiology of the chronic pancreatitis was alcoholic (77 %), idiopathic (18 %), or hereditary (5 %). Patients were followed up for a median period of 69 months (range 14 - 163 months) after study entry, including a median period of 27 months (range 12 - 126 months) after stent removal. The median duration of pancreatic stenting before stent removal was 23 months (range 2 - 134 months). After attempted definitive stent removal, 30 patients (30 %) required re-stenting within the first year of follow-up, at a median time of 5.5 months after stent removal (range 1 - 12 months), while in 70 patients (70 %) pain control remained adequate during that period. By the end of the follow-up period a total of 38 patients had required re-stenting and four ultimately underwent pancreaticojejunostomy. Pancreas divisum was the only factor significantly associated with a higher risk of re-stenting (P = 0.002).

CONCLUSIONS

The majority (70 %) of patients with severe chronic pancreatitis who respond to pancreatic stenting maintain this response after definitive stent removal. However, a significantly higher re-stenting rate was observed in patients with chronic pancreatitis and pancreas divisum.

摘要

背景与研究目的

尽管已证实胰管支架置入术在重度慢性胰腺炎的症状管理中有效，但支架取出后的长期疗效尚未得到充分评估。

患者与方法

共有100例重度慢性胰腺炎伴胰管狭窄患者（75例男性，25例女性；中位年龄49岁）使用聚乙烯胰管支架成功治疗胰性疼痛，并在支架取出后至少随访1年。支架根据需要进行更换（疼痛复发时），并根据临床和内镜检查结果尝试进行最终的支架取出。回顾性评估临床变量作为再次置入支架的潜在预测因素。

结果

慢性胰腺炎的病因是酒精性（77%）、特发性（18%）或遗传性（5%）。研究入组后患者的中位随访时间为69个月（范围14 - 163个月），其中支架取出后的中位随访时间为27个月（范围12 - 126个月）。支架取出前胰管支架置入的中位持续时间为23个月（范围2 - 134个月）。在尝试进行最终的支架取出后，30例患者（30%）在随访的第一年需要再次置入支架，中位时间为支架取出后5.5个月（范围1 - 12个月），而70例患者（70%）在此期间疼痛控制良好。到随访期结束时，共有38例患者需要再次置入支架，4例最终接受了胰空肠吻合术。胰腺分裂是与再次置入支架风险较高显著相关的唯一因素（P = 0.002）。