Jürgensen Christian, Brückner Stefan, Reichel Stephanie, Kilian Maik, Pannach Sven, Distler Marius, Weitz Jürgen, Neser Frank, Hampe Jochen, Will Uwe
Department of Hepatology and Gastroenterology, Charité University Medicine, Berlin, Germany.
Medical Department 1, University Hospital Dresden, Technical University Dresden (TUD), Dresden, Germany.
Dig Endosc. 2017 May;29(3):377-382. doi: 10.1111/den.12817. Epub 2017 Mar 20.
Minimally invasive or endoscopic transluminal drainage and necrosectomy are the standard of care for infected pancreatic fluid collections and necroses after pancreatitis. In an endoscopic treatment algorithm, necroses beyond the reach of safe endoscopic access are typically treated by percutaneous drainage. We aimed to evaluate percutaneous minimally invasive necrosectomy using a purely endoscopic technique in patients with extensive necrosis. In patients with necroses beyond safe transluminal reach, the percutaneous drainage canal was used for flexible endoscopic access and dilatation of the tract to 20 mm. Percutaneous endoscopic necrosectomy was carried out through this canal. We present a case series of 14 patients in whom between one and four necrosectomy (median two) sessions were done to remove solid necroses successfully in 13 out of 14 patients. There were no major complications apart from one patient with abdominal compartment syndrome secondary to delayed erosion of the splenic artery. Percutaneous flexible necrosectomy might evolve into an alternative to surgical minimally invasive necrosectomy in anatomical sites beyond transluminal endoscopic reach.
微创或内镜下经腔引流及坏死组织清除术是胰腺炎后感染性胰液积聚和坏死的标准治疗方法。在内镜治疗方案中，安全内镜无法触及的坏死灶通常采用经皮引流治疗。我们旨在评估在广泛坏死患者中使用纯内镜技术进行经皮微创坏死组织清除术。对于经腔无法安全触及的坏死灶患者，经皮引流通道用于灵活的内镜进入，并将通道扩张至20毫米。通过该通道进行经皮内镜坏死组织清除术。我们报告了一个包含14例患者的病例系列，其中1至4次（中位数为2次）坏死组织清除术成功清除了14例患者中13例的实性坏死灶。除1例因脾动脉延迟侵蚀继发腹腔间隔室综合征的患者外，无其他严重并发症。经皮柔性坏死组织清除术可能会成为经腔内镜无法触及的解剖部位手术微创坏死组织清除术的替代方法。
