Kato Shin, Katanuma Akio, Maguchi Hiroyuki, Takahashi Kuniyuki, Osanai Manabu, Yane Kei, Kim Toshifumi, Kaneko Maki, Takaki Ryo, Matsumoto Kazuyuki, Matsumori Tomoaki, Gon Katsushige, Tomonari Akiko
Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo 006-8555, Japan.
Diagn Ther Endosc. 2013;2013:924291. doi: 10.1155/2013/924291. Epub 2013 Mar 10.
Background and Aim. EUS-guided transmural drainage (EUS-GTD) is now considered a minimally invasive and effective alternative to surgery for drainage of symptomatic pancreatic pseudocysts. However, the technique is rather difficult, and sometimes serious complications occur to patients undergoing this procedure. We retrospectively evaluated efficacy, safety, and long-term follow-up results of EUS-GTD for pancreatic pseudocyst. Methods. Sixty-seven patients with pancreatic pseudocyst who underwent EUS-GTD from April 2000 to March 2011 were enrolled. We retrospectively evaluated (1) technical success, (2) clinical success, (3) adverse event of procedure, and (4) long-term follow-up results. Results. Total technical success rate was 88%. Ninety-one percent of external drainage, 79% of internal drainage, and 66% of puncture and aspiration only achieved clinical success. There was only one case with an adverse event, perforation (1.5%). The case required emergency operation. Total recurrence rate was 23.9%. Median follow-up period was 33.9 months. The recurrence rates in the cases of stent remaining, spontaneously dislodged, removed on schedule, external tube removal, and aspiration only were 10.0%, 12.5%, 42.9%, 50%, and 0%, respectively. Conclusion. EUS-GTD is a relatively safe and effective therapeutic method. However, further analysis should be done by larger series to determine the method of EUS-GTD for pancreatic pseudocyst.
背景与目的。内镜超声引导下经壁引流术（EUS-GTD）目前被认为是治疗有症状胰腺假性囊肿的一种微创且有效的手术替代方法。然而，该技术操作难度较大，接受此手术的患者有时会出现严重并发症。我们回顾性评估了EUS-GTD治疗胰腺假性囊肿的疗效、安全性及长期随访结果。方法。纳入2000年4月至2011年3月期间接受EUS-GTD治疗的67例胰腺假性囊肿患者。我们回顾性评估了（1）技术成功率，（2）临床成功率，（3）手术不良事件，以及（4）长期随访结果。结果。总技术成功率为88%。外引流的临床成功率为91%，内引流为79%，单纯穿刺抽吸为66%。仅1例出现不良事件，即穿孔（1.5%）。该病例需急诊手术。总复发率为23.9%。中位随访期为33.9个月。支架留置、自行脱落、按期取出、拔除外引流管及单纯抽吸病例的复发率分别为10.0%﹑12.5%﹑42.9%﹑50%和0%。结论。EUS-GTD是一种相对安全有效的治疗方法。然而，需要通过更大样本量的研究进一步分析以确定EUS-GTD治疗胰腺假性囊肿的方法。
