DeSimone Michael L, Asombang Akwi W, Berzin Tyler M
Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States.
Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States.
World J Gastrointest Endosc. 2017 Sep 16;9(9):456-463. doi: 10.4253/wjge.v9.i9.456.
For patients recovering from acute pancreatitis, the development of a pancreatic fluid collection (PFC) predicts a more complex course of recovery, and introduces difficult management decisions with regard to when, whether, and how the collection should be drained. Most PFCs resolve spontaneously and drainage is indicated only in pseudocysts and walled-off pancreatic necrosis when the collections are causing symptoms and/or local complications such as biliary obstruction. Historical approaches to PFC drainage have included surgical (open or laparoscopic cystgastrostomy or pancreatic debridement), and the placement of percutaneous drains. Endoscopic drainage techniques have emerged in the last several years as the preferred approach for most patients, when local expertise is available. Lumen-apposing metal stents (LAMS) have recently been developed as a tool to facilitate potentially safer and easier endoscopic drainage of pancreatic fluid collections, and less commonly, for other indications, such as gallbladder drainage. Physicians considering LAMS placement must be aware of the complications most commonly associated with LAMS including bleeding, migration, buried stent, stent occlusion, and perforation. Because of the patient complexity associated with severe pancreatitis, management of pancreatic fluid collections can be a complex and multidisciplinary endeavor. Successful and safe use of LAMS for patients with pancreatic fluid collections requires that the endoscopist have a full understanding of the potential complications of LAMS techniques, including how to recognize and manage expected complications.
对于急性胰腺炎康复期的患者，胰液积聚（PFC）的出现预示着康复过程会更加复杂，并且在何时、是否以及如何引流积聚物方面带来了艰难的管理决策。大多数PFC会自行消退，仅在假性囊肿和包裹性胰腺坏死且积聚物引起症状和/或局部并发症（如胆道梗阻）时才需要引流。PFC引流的传统方法包括手术（开放或腹腔镜囊肿胃造口术或胰腺清创术）以及放置经皮引流管。在过去几年中，当有当地专业技术支持时，内镜引流技术已成为大多数患者的首选方法。管腔对合金属支架（LAMS）最近已被开发出来，作为一种有助于更安全、更容易地进行胰液积聚内镜引流的工具，较少用于其他适应症，如胆囊引流。考虑放置LAMS的医生必须了解与LAMS最常见相关的并发症，包括出血、移位、支架埋入、支架阻塞和穿孔。由于与重症胰腺炎相关的患者情况复杂，胰液积聚的管理可能是一项复杂的多学科工作。成功且安全地将LAMS用于胰液积聚患者要求内镜医师充分了解LAMS技术的潜在并发症，包括如何识别和处理预期并发症。
