Larsen Michael, Kozarek Richard
Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA.
J Gastroenterol Hepatol. 2014;29(7):1360-70. doi: 10.1111/jgh.12574.
Pancreatic duct leaks can occur as a result of both acute and chronic pancreatitis or in the setting of pancreatic trauma. Manifestations of leaks include pseudocysts, pancreatic ascites, high amylase pleural effusions, disconnected duct syndrome, and internal and external pancreatic fistulas. Patient presentations are highly variable and range from asymptomatic pancreatic cysts to patients with severe abdominal pain and sepsis from infected fluid collections. The diagnosis can often be made by high-quality cross-sectional imaging or during endoscopic retrograde cholangiopancreatography (ERCP). Because of their complexity, pancreatic leak patients are best managed by a multidisciplinary team comprised of therapeutic endoscopists, interventional radiologists, and surgeons in the field of pancreatic interventions. Minor leaks will often resolve with conservative management while severe leaks will frequently require interventions. Endoscopic treatments for pancreatic duct leaks have replaced surgical interventions in many situations. Interventional radiologists also have the ability to offer therapeutic interventions for many leak patients. The mainstay of endotherapy for pancreatic leaks is transpapillary pancreatic duct stenting with a stent that bridges the leak if possible, but varies based on the manifestation and clinical presentation. Fluid collections that result from leaks, such as pseudocysts, can often be treated by endoscopic transluminal drainage with or without endoscopic ultrasound or by percutaneous drainage. Endoscopic interventions have been shown to be effective and have an acceptable complication rate.
胰腺导管漏可由急性和慢性胰腺炎引起，也可发生于胰腺创伤的情况下。漏出的表现包括假性囊肿、胰性腹水、高淀粉酶胸腔积液、胰腺导管离断综合征以及胰腺内外瘘。患者的临床表现差异很大，从无症状的胰腺囊肿到因感染性积液导致严重腹痛和脓毒症的患者都有。诊断通常可通过高质量的横断面成像或在逆行胰胆管造影术（ERCP）过程中做出。由于其复杂性，胰腺漏患者最好由一个多学科团队管理，该团队由治疗内镜医师、介入放射科医生和胰腺介入领域的外科医生组成。轻微的漏通常通过保守治疗即可解决，而严重的漏则常常需要进行干预。在许多情况下，内镜治疗已取代了胰腺导管漏的外科手术干预。介入放射科医生也能够为许多漏患者提供治疗性干预措施。胰腺漏内镜治疗的主要方法是经乳头胰腺导管支架置入术，使用的支架如果可能应跨越漏口，但会根据表现和临床表现而有所不同。漏出导致的积液，如假性囊肿，通常可通过内镜腔内引流（有无内镜超声引导均可）或经皮引流进行治疗。内镜干预已被证明是有效的，且并发症发生率可接受。
