Naitoh Itaru, Ohara Hirotaka, Okayama Yasutaka, Nakazawa Takahiro, Ando Tomoaki, Hayashi Kazuki, Okumura Fumihiro, Kitajima Yasuhiro, Ban Tessin, Miyabe Katsuyuki, Ueno Koichiro, Joh Takashi, Sano Hitoshi
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya.
Case Rep Gastroenterol. 2008 Sep;2(3):390-7. doi: 10.1159/000163377. Epub 2008 Nov 11.
We report a 50-year-old male with pseudocysts in the pancreatic tail associated with chronic pancreatitis successfully treated by transpapillary cyst drainage. He had previously undergone ultrasonography-guided percutaneous cyst drainage for a pancreatic pseudocyst in our hospital. He was readmitted due to abdominal pain and fever. Computed tomography showed recurrence of a pseudocyst in the pancreatic tail measuring 5 cm in diameter. Since conservative treatment failed, endoscopic retrograde pancreatography was performed. There was communication between the pseudocyst and the main pancreatic duct, and pancreatic duct stenosis proximal to the pseudocyst. First, transpapillary pancreatic duct drainage was performed using a plastic stent, but the pseudocyst did not decrease in size and became infected. After removal of the stent, a pigtail type nasocystic catheter was placed in the pseudocyst via the pancreatic duct. The pseudocyst infection immediately disappeared, and the pseudocyst gradually decreased and disappeared. After removal of the nasocystic catheter, no recurrence was observed. As transpapillary drainage of pancreatic pseudocyst, cyst drainage and pancreatic duct drainage have been reported. In our patient with pseudocyst in the pancreatic tail, duct drainage was ineffective and the pseudocyst was infected, whereas cyst drainage was very effective. We considered that cyst drainage by a nasocystic catheter was the first-line therapy as the transpapillary drainage of the pancreatic pseudocyst.
我们报告一例50岁男性，其胰尾假性囊肿与慢性胰腺炎相关，经乳头囊肿引流术成功治疗。他此前曾在我院接受超声引导下经皮胰腺假性囊肿引流术。因腹痛和发热再次入院。计算机断层扫描显示胰尾假性囊肿复发，直径5厘米。由于保守治疗失败，遂行内镜逆行胰胆管造影术。假性囊肿与主胰管相通，且假性囊肿近端胰管狭窄。首先，使用塑料支架行经乳头胰管引流，但假性囊肿大小未减小且发生感染。移除支架后，经胰管在假性囊肿内放置一根猪尾型鼻囊肿导管。假性囊肿感染立即消失，假性囊肿逐渐缩小并消失。移除鼻囊肿导管后，未见复发。关于经乳头引流胰腺假性囊肿，已有囊肿引流和胰管引流的报道。在我们这位胰尾假性囊肿患者中，胰管引流无效且假性囊肿感染，而囊肿引流非常有效。我们认为，经鼻囊肿导管进行囊肿引流作为胰腺假性囊肿的经乳头引流是一线治疗方法。
