Liu Shi-Yi, Mao Ai-Wu, Jia Yi-Ping, Wang Zhen-Lei, Jiang Hao-Sheng, Li Yong-Dong, Yin Xiang
Hepatogastroenterology. 2014 Mar-Apr;61(130):475-9.
BACKGROUND/AIMS: To retrospective evaluate the incidence, predictive factors, and management of acute pancreatitis after placement of duodenal stent in patients with malignant gastroduodenal obstruction.
Among 242 patients with symptomatic malignant gastroduodenal obstruction successfully treated with duodenal stent placement, acute pancreatitis occurred in 10 (4.1%) of the patients 1-7 days after stent placement. The variables were analyzed. Univariate and multivariate analysis was performed to evaluate factors predictive of acute pancreatitis. Management of acute pancreatitis also was evaluated.
All patients with acute pancreatitis were presented with abdominal pain and distention with vomiting 1-7 days after stent placement, in which 7 patients developed acute janudice. Four patients were cured by fasting and intravenous nutrition, and the remaining 6 cases were managed with percutaneous cholangiography and drain placement (PTCD). Univariate analysis showed acute pancreatitis was associated with location in the descending duodenum (p = 0.001) and stent bridge the duodenal papilla (p < 0.001). Multivariate analysis exhibited that the presence of stent bridged the duodenal papilla (odds ratio (OR), 18.48; 95% CI, 2.298-148.48; p = 0.006) was independent predictors of acute pancreatitis.
Acute pancreatitis is an uncommon early complication of placement of duodenal stents in patients with malignant gastroduodenal obstruction. Acute pancreatitis occurred most commonly in descending duodenum, and in patients with stent bridged the duodenal papilla. Stent bridged the duodenal papilla may be the most important predictors for acute pancreatitis. Acute pancreatitis can be managed conservatively or by PTCD when developed to acute jaundice.
背景/目的：回顾性评估恶性胃十二指肠梗阻患者十二指肠支架置入术后急性胰腺炎的发生率、预测因素及处理方法。
在242例因症状性恶性胃十二指肠梗阻成功接受十二指肠支架置入术的患者中，10例（4.1%）在支架置入后1 - 7天发生急性胰腺炎。对各项变量进行分析。采用单因素和多因素分析评估急性胰腺炎的预测因素。同时对急性胰腺炎的处理方法进行评估。
所有急性胰腺炎患者在支架置入后1 - 7天均出现腹痛、腹胀伴呕吐，其中7例出现急性黄疸。4例患者通过禁食和静脉营养治愈，其余6例采用经皮肝穿刺胆管造影及引流置管术（PTCD）处理。单因素分析显示急性胰腺炎与十二指肠降部位置（p = 0.001）及支架跨越十二指肠乳头（p < 0.001）有关。多因素分析表明，支架跨越十二指肠乳头（比值比（OR），18.48；95%可信区间，2.298 - 148.48；p = 0.006）是急性胰腺炎的独立预测因素。
急性胰腺炎是恶性胃十二指肠梗阻患者十二指肠支架置入术后少见的早期并发症。急性胰腺炎最常发生于十二指肠降部，且在支架跨越十二指肠乳头的患者中出现。支架跨越十二指肠乳头可能是急性胰腺炎最重要的预测因素。急性胰腺炎发生急性黄疸时可采用保守治疗或PTCD处理。
