Sharma Shyam S, Singh Bir, Jain Mukesh, Maharshi Sudhir, Nijhawan Sandeep, Sapra Bharat, Jhajharia Ashok
Department of Gastroenterology, Sawai Man Singh Medical College, Jawaharlal Nehru Marg, Gangawal Park, Jaipur, 302 004, India.
Department of Gastroenterology, G B Pant Hospital, 1, Jawaharlal Nehru Marg, New Delhi, 110 002, India.
Indian J Gastroenterol. 2016 Jan;35(1):40-7. doi: 10.1007/s12664-016-0624-5. Epub 2016 Feb 29.
To determine long-term outcome of endoscopic management of pancreatic pseudocyst/walled-off pancreatic necrosis (WOPN) without necrosectomy.
One-hundred and sixty-five pancreatic pseudocysts/WOPN managed endoscopically over a period of 22 years were analyzed retrospectively for technical success, complications, and recurrence.
Symptomatic 118 males and 47 females with mean age of 35.8 years were included. Alcohol was the most common etiology (41.2%). Transmural endoscopic drainage was done in 144 patients, while 21 patients underwent transpapillary drainage. All the patients were subjected to contrast computed tomography (CT) abdomen or routine/Doppler ultrasound. Endoscopic ultrasound was done in last 11 patients. One or two double pigtail 7 Fr stents were placed when clear watery fluid came out from cyst (130 patients, 78.8%), and nasocystic drainage (NCD) tubes were placed in addition to two 7 Fr stents when there were frank pus, thick dark fluid, or solid components inside the cyst (35 patients). All these patients settled on this treatment. Thirty-three of 35 patients of WOPN could be managed endoscopically without necrosectomy. Complications occurred in 9.2% of pseudocysts and 40% of WOPN. Thirty-five patients were followed up for more than 5 years (3 patients more than 10 years), and 130 patients were followed up for up to 5 years. Recurrence occurred in 8.1% of pseudocysts and 5.7% of WOPN.
Majority of pancreatic pseudocysts/WOPN can be managed with endoscopic drainage without necrosectomy with high success, low complication, and recurrence rates.
确定不进行坏死组织清除术的内镜治疗胰腺假性囊肿/包裹性胰腺坏死（WOPN）的长期疗效。
回顾性分析22年间接受内镜治疗的165例胰腺假性囊肿/WOPN患者的技术成功率、并发症及复发情况。
纳入118例男性和47例女性有症状患者，平均年龄35.8岁。酒精是最常见病因（41.2%）。144例患者行透壁内镜引流，21例患者行经乳头引流。所有患者均接受腹部对比计算机断层扫描（CT）或常规/多普勒超声检查。最后11例患者行内镜超声检查。当囊肿引出清亮水样液体时，放置1或2根7F双猪尾支架（130例患者，78.8%）；当囊肿内有脓性、浓稠深色液体或实性成分时，除放置2根7F支架外，还放置鼻囊肿引流（NCD）管（35例患者）。所有这些患者经此治疗后病情缓解。35例WOPN患者中的33例可在内镜下不进行坏死组织清除术进行治疗。假性囊肿患者并发症发生率为9.2%，WOPN患者为40%。35例患者随访超过5年（3例超过10年），130例患者随访至5年。假性囊肿复发率为8.1%，WOPN复发率为5.7%。
大多数胰腺假性囊肿/WOPN可通过内镜引流治疗，无需进行坏死组织清除术，成功率高、并发症及复发率低。
