远端胰腺切除及摘除术后胰瘘的内镜治疗
Endoscopic management of pancreatic fistula after distal pancreatectomy and enucleation.
作者信息
Goasguen Nicolas, Bourrier Anne, Ponsot Philippe, Bastien Laurence, Lesurtel Mickael, Prat Frederic, Dousset Bertrand, Sauvanet Alain
机构信息
Department of Hepatobiliary and Pancreatic Surgery, AP-HP, Beaujon Hospital, University Paris VII, Clichy, France.
出版信息
Am J Surg. 2009 Jun;197(6):715-20. doi: 10.1016/j.amjsurg.2008.03.005. Epub 2008 Sep 11.
BACKGROUND
Preoperative endoscopic pancreatic sphincterotomy (EPS) has been proposed to prevent postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) or enucleation (EN). The use of EPS as a curative treatment for POPF has been scarcely reported. We reported 10 consecutive patients who were successfully treated by EPS for a prolonged POPF.
STUDY DESIGN
Ten patients underwent EPS for prolonged POPF (median duration = 40 days, range 20-114; median daily output = 80 mL, range 50-250) after 6 DPs, 2 ENs, and 2 medial pancreatectomies.
RESULTS
EPS was performed in all patients, with stent insertion in 4. No patient developed a specific complication because of EPS. POPF healed within a median delay of 4 days (range 1-12). One patient underwent a repeated endoscopy to treat stent malposition. The median delay of discharge after EPS was 13 days (range 8-15). With a 20-month median follow up, 1 patient developed early transient POPF recurrence because of spontaneous stent migration.
CONCLUSIONS
EPS is indicated for prolonged POPF after DP or EN because it is highly feasible, shortens healing, and is well tolerated.
背景
术前内镜下胰括约肌切开术（EPS）已被提议用于预防远端胰腺切除术（DP）或摘除术（EN）后发生术后胰瘘（POPF）。关于将EPS用作POPF的根治性治疗方法的报道很少。我们报告了连续10例因持续性POPF而通过EPS成功治疗的患者。
研究设计
10例患者在6例DP、2例EN和2例中段胰腺切除术后因持续性POPF接受了EPS治疗（中位持续时间=40天，范围20 - 114天；中位每日引流量=80 mL，范围50 - 250 mL）。
结果
所有患者均接受了EPS治疗，4例置入了支架。没有患者因EPS出现特定并发症。POPF在中位延迟4天（范围1 - 12天）内愈合。1例患者接受了重复内镜检查以治疗支架位置异常。EPS术后出院的中位延迟时间为13天（范围8 - 15天）。中位随访20个月时，1例患者因支架自发移位出现早期短暂性POPF复发。
结论
DP或EN后发生持续性POPF时，EPS是适用的，因为它具有高度可行性，能缩短愈合时间，且耐受性良好。
Zotero 插件