Department of Gastroenterology and Gastrointestinal Surgery, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650, Hvidovre, Denmark.
Dig Dis Sci. 2018 Sep;63(9):2456-2465. doi: 10.1007/s10620-018-5131-3. Epub 2018 May 24.
The recommended treatment of infected walled-off necrosis (WON) in necrotizing pancreatitis entails a step-up treatment approach starting with endoscopic necrosectomy (ETDN).
To report a small number of cases from 2013 to 2016 that were not amenable to or failed to respond to ETDN, and to describe a new, minimally invasive technique that may be a promising supplement to ETDN in this difficult patient population.
Using the Seldinger technique, a fully covered self-expanding metal stent (SEMS) was placed percutaneously in order to drain, irrigate, and debride WON. After resolution, the stent was removed. We reviewed electronic patient records and defined clinical success as complete WON resolution with removal of internal as well as percutaneous drains and stents.
Five patients underwent treatment with SEMS placement. The mean length of the WON was 33.4 cm. Clinical success was achieved in four patients after an average of 5.75 necrosectomy sessions. One patient died from severe sepsis. Adverse events included severe abdominal pain and productive cutaneous fistulae (two patients).
In our small case series, endoscopic necrosectomy through a percutaneous SEMS seemed beneficial and safe in the treatment of infected WON.
推荐的治疗方法是对坏死性胰腺炎伴感染性隔离坏死（WON）采用逐步升级的治疗方法，从内镜下坏死组织清除术（ETDN）开始。
报告 2013 年至 2016 年期间的少数几例病例，这些病例不适合或对 ETDN 无反应，并描述一种新的微创技术，该技术可能是这种困难患者群体中 ETDN 的有前途的补充。
使用 Seldinger 技术，经皮放置全覆膜自膨式金属支架（SEMS）以引流、冲洗和清创 WON。WON 解决后，取出支架。我们回顾了电子患者记录，并将临床成功定义为完全清除 WON，同时去除内部和经皮引流管和支架。
五名患者接受了 SEMS 放置治疗。WON 的平均长度为 33.4cm。经过平均 5.75 次坏死组织清除术，四名患者的临床成功。一名患者死于严重败血症。不良事件包括严重腹痛和有分泌物的皮肤瘘管（两名患者）。
在我们的小病例系列中，经皮 SEMS 的内镜下坏死组织清除术似乎对治疗感染性 WON 是有益且安全的。
