Bhasin Deepak Kumar, Rana Surinder Singh, Rao Chalapathi, Gupta Rajesh, Verma Ganga Ram, Kang Mandeep, Nagi Birinder, Singh Kartar
Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India.
JOP. 2012 Mar 10;13(2):187-92.
There is limited experience with pancreatic endotherapy in patients with pancreatic injury due to trauma.
To retrospectively evaluate our experience of endoscopic management of pancreatic trauma.
Eleven patients (10 males and 1 female; mean age: 21.8±11.9 years) with pancreatic trauma.
Endoscopic therapy. Patients with pseudocyst and a gastroduodenal bulge were treated with endoscopic transmural drainage. Pseudocysts without bulge or patients with external pancreatic fistula were treated with transpapillary drainage.
Seven patients (6 males, 1 female) were treated for symptomatic pseudocyst and 4 patients (all males) were treated for persistent external pancreatic fistula. Three patients with external pancreatic fistula had partial disruption of pancreatic duct (head: 2 cases; tail: 1 case) and were successfully treated with bridging pancreatic stent (2 cases) or bridging nasopancreatic drain (1 case) with resolution of external pancreatic fistula in 4 to 6 weeks. Of seven patients presenting with symptomatic pseudocyst (size range: 4-14 cm), two patients were successfully treated with cystogastrostomy and there has been no recurrence over a follow up of 20 and 16 months, respectively. Five patients underwent transpapillary drainage. Three patients had partial disruption and two had complete disruption. In the former, a bridging nasopancreatic drain was placed in one patient and stent in two patients. All three patients had resolution of pseudocyst within 8 weeks and there has been no recurrence over a follow-up of 11 to 70 months. In two patients with complete disruption, non-bridging stent did not resolve the pseudocysts and required surgery.
Pancreatic injury due to trauma can be effectively treated endoscopically.
对于因创伤导致胰腺损伤的患者，胰腺内镜治疗的经验有限。
回顾性评估我们对胰腺创伤进行内镜治疗的经验。
11例胰腺创伤患者（10例男性，1例女性；平均年龄：21.8±11.9岁）。
内镜治疗。对于有假性囊肿和胃十二指肠隆起的患者，采用内镜经壁引流。对于无隆起的假性囊肿患者或胰外瘘患者，采用经乳头引流。
7例患者（6例男性，1例女性）因有症状的假性囊肿接受治疗，4例患者（均为男性）因持续性胰外瘘接受治疗。3例胰外瘘患者存在胰管部分断裂（头部：2例；尾部：1例），通过置入桥接胰管支架（2例）或桥接鼻胰引流管（1例）成功治疗，胰外瘘在4至6周内愈合。7例有症状假性囊肿患者（大小范围：4 - 14 cm）中，2例通过囊肿胃吻合术成功治疗，分别随访20个月和16个月均无复发。5例患者接受经乳头引流。3例存在部分断裂患者，1例置入桥接鼻胰引流管，2例置入支架。所有3例患者的假性囊肿在8周内消失，随访11至70个月均无复发。2例完全断裂患者，非桥接支架未能消除假性囊肿，需行手术治疗。
创伤性胰腺损伤可通过内镜有效治疗。
