Rana Surinder Singh, Bhasin Deepak Kumar, Rao Chalapathi, Sharma Ravi, Gupta Rajesh
Department of Gastroenterology (Surinder Singh Rana, Deepak Kumar Bhasin, Chalapathi Rao, Ravi Sharma).
Department of Surgery (Rajesh Gupta), Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Ann Gastroenterol. 2014;27(2):162-166.
Patients with acute necrotizing pancreatitis may develop pancreatic insufficiency and this is commonly seen in patients who have undergone surgery for pancreatic necrosis. Owing to the paucity of relative data, we retrospectively evaluated the structural and functional changes in the pancreas after endoscopic and surgical management of pancreatic necrosis.
The records of patients who underwent endoscopic transmural drainage of walled off pancreatic necrosis (WOPN) over the last 3 years and who completed at least 6 months of follow up were analyzed. Structural and functional changes in these patients were compared with 25 historical surgical controls (operated in 2005-2006).
Twenty six patients (21 M; mean age 35.4±8.1 years) who underwent endoscopic drainage for WOPN were followed up for 22.3±8.6 months. During the follow up, five (19.2%) patients developed diabetes with 3 patients requiring insulin and 1 patient with steatorrhea requiring pancreatic enzyme supplementation. The pancreatic fluid collection (PFC) recurred in 1 patient whose stents spontaneously migrated out. On follow up, in the surgery group, 2 (8%) patients developed steatorrhea and 11 (44%) developed diabetes. Five (20%) of these patients had recurrence of PFC. On comparison of follow up results of endoscopic drainage with surgery, recurrence rates as well as frequency of endocrine and exocrine insufficiency was lower in the endoscopic group but difference was not significant.
Structural and functional impairment of pancreas is seen less frequently in patients with pancreatic necrosis treated endoscopically compared to patients undergoing surgery, although the difference was insignificant. Further studies with large sample size are needed to confirm these initial results.
急性坏死性胰腺炎患者可能会出现胰腺功能不全，这在接受胰腺坏死手术的患者中很常见。由于相关数据较少，我们回顾性评估了胰腺坏死经内镜和手术治疗后胰腺的结构和功能变化。
分析过去3年接受内镜下经壁引流治疗包裹性胰腺坏死（WOPN）且完成至少6个月随访的患者记录。将这些患者的结构和功能变化与25例历史手术对照患者（2005 - 2006年接受手术）进行比较。
26例接受WOPN内镜引流的患者（21例男性；平均年龄35.4±8.1岁）接受了22.3±8.6个月的随访。随访期间，5例（19.2%）患者发生糖尿病，其中3例需要胰岛素治疗，1例脂肪泻患者需要补充胰酶。1例患者的支架自行移出，胰腺液体积聚（PFC）复发。随访时，手术组有2例（8%）患者发生脂肪泻，11例（44%）发生糖尿病。这些患者中有5例（20%）PFC复发。将内镜引流与手术的随访结果进行比较，内镜组的复发率以及内分泌和外分泌功能不全的发生率较低，但差异不显著。
与接受手术的患者相比，内镜治疗胰腺坏死患者的胰腺结构和功能损害较少见，尽管差异不显著。需要进一步进行大样本研究来证实这些初步结果。
