Budzinskiĭ S A, Shapoval'iants S G, Fedorov E D, Myl'nikov A G, Bakaev Z R, Bakhtiozina D V
Eksp Klin Gastroenterol. 2014(3):72-80.
For the last years the role of endoscopic pancreatic stenting in the treatment of chronic pancreatitis and its complica- tions has significantly increased.
In the clinic of abdominal surgery and endoscopy of Pirogov RNRMU based on the University Hospital 31 for the period from 01.1998 to 01.2014 Wirsung duct occlusion, which developed on the background of CP was the cause of performing of 215 endoscopic procedures in 95 patients: 34 (35.8%) women and 61 (64.2%) men. Mean age 49.8 ± 11.7 years. Study group consisted of 52 (54.7%) patients with strictures of MPD and 43 (45.3%) with pancreatic fistulas. We tried to perform pancreatic stenting in all the cases, as a method of treatment of pathological changes in the pancreatic ductal system.
Endoscopic stenting was successfully performed in 64 cases (67.4%), while in 45 (70.3%) cases, this intervention was the definitive method of treatment. Temporary Wirsung duct stenting was performed in 19 (29.7%) cases in which endoscopic retrograde step interven- tions were training to perform surgery. It is significant that the main causes of the technical impossibility of pancreatic stenting was the complete dissociation of Wirsung duct (8), distal localization of occlusive lesions (13), presence of severe angulation in stenotic changes (20) and the length of the scar stricture of the MPD more than 1 cm (17) and particularly a combination of several factors. Clinically significant complications after endoscopic interventions in our study occurred in 6 (2.8%) cases. Lethal outcome occurred in one patient (0.5%).
According to the results of our study pancreatic stenting was technically feasible in 67.4% of all cases. At the same time, endoscopic correction, if the possibility of its technical implementation, may be the final method of treatment in 70.3% cases. In this endoscopic pancreatic stenting has a low complication rate (2.8%) and mortality (0.5%). The main reasons for the failures and limitations of endoscopic stage treatment is a combination of factors: complete dissociation of the MPD, distal location of the Wirsung duct strictures with severe angulation in this area and a large length of strictures.
在过去几年中，内镜下胰腺支架置入术在慢性胰腺炎及其并发症治疗中的作用显著增强。
在皮罗戈夫俄罗斯国立研究医科大学附属大学医院31号腹部外科和内镜科，1998年1月至2014年1月期间，95例患者因慢性胰腺炎背景下出现的主胰管闭塞而接受了215例内镜手术：34例（35.8%）女性和61例（64.2%）男性。平均年龄49.8±11.7岁。研究组包括52例（54.7%）主胰管狭窄患者和43例（45.3%）胰瘘患者。我们试图在所有病例中进行胰腺支架置入术，作为治疗胰管系统病理改变的一种方法。
64例（67.4%）成功进行了内镜下支架置入术，其中45例（70.3%）该干预为确定性治疗方法。19例（29.7%）进行了临时性主胰管支架置入术，这些病例中内镜逆行分步干预是为手术做准备。值得注意的是，胰腺支架置入术技术上无法实施的主要原因是主胰管完全离断（8例）、闭塞性病变位于远端（13例）、狭窄改变处存在严重成角（20例）以及主胰管瘢痕狭窄长度超过1cm（17例），尤其是多种因素并存。在我们的研究中，内镜干预后发生的具有临床意义的并发症有6例（2.8%）。1例患者死亡（0.5%）。
根据我们的研究结果，胰腺支架置入术在所有病例中的技术成功率为67.4%。同时，如果技术上可行，内镜矫正可能是70.3%病例的最终治疗方法。在此，内镜下胰腺支架置入术的并发症发生率低（2.8%），死亡率低（0.5%）。内镜分期治疗失败和受限的主要原因是多种因素的组合：主胰管完全离断、主胰管狭窄位于远端且该区域存在严重成角以及狭窄长度较长。
