Theerasuwipakorn Nonthikorn, Tasneem Abbas Ali, Kongkam Pradermchai, Angsuwatcharakon Phontep, Ridtitid Wiriyaporn, Navicharern Patpong, Kitisin Krit, Wangrattanapranee Peerapol, Rerknimitr Rungsun, Kullavanijaya Pinit
Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Faculty of Medicine, Chulalongkorn University Society, Bangkok, Thailand.
Gastrointestinal Endoscopy Excellence Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
J Transl Int Med. 2019 Dec 31;7(4):170-177. doi: 10.2478/jtim-2019-0032. eCollection 2019 Dec.
Drainage of symptomatic walled-off peripancreatic fluid collections (WPFCs) can be achieved by endoscopic, percutaneous, and surgical techniques. The aim of this study was to determine the current trends in management of WPFCs and the outcome of such modalities in Asian population.
In this retrospective analysis, all patients diagnosed with pancreatitis from 2013 to 2016 in King Chulalongkorn Memorial Hospital, Bangkok, Thailand, were analyzed. Relevant clinical data of all patients with peripancreatic fluid collections (PFCs) was reviewed. Clinical success was defined as improvement in symptoms after drainage.
Of the total 636 patients with pancreatitis, 72 (11.3%) had WPFCs, of which 55 (8.6%) and 17 (2.7%) had pancreatic pseudocyst (PP) and walled-off necrosis (WON), respectively. The commonest etiologies of WPFCs were alcohol (38.9%) and biliary stone (29.2%). Post-procedure and pancreatic tumor related pancreatitis was found in 8.3% and 6.9% patients, respectively. PP was more common in chronic (27.8%) than acute (5.5%) pancreatitis. Of the 72 patients with WPFCs, 31 (43.1%) had local complications. Supportive, endoscopic, percutaneous, and surgical drainage were employed in 58.3%, 27.8%, 8.3%, and 5.6% with success rates being 100%, 100%, 50%, and 100%, respectively. Complications that developed after percutaneous drainage included bleeding at procedure site ( = 1), infection of PFC ( = 1), and pancreatic duct leakage ( = 1).
Over the past few years, endoscopic drainage has become the most common route of drainage of WPFCs followed by percutaneous and surgical routes. The success rate of endoscopic route is better than percutaneous and comparable to surgical modality.
有症状的胰腺周围包裹性积液（WPFCs）可通过内镜、经皮和手术技术进行引流。本研究的目的是确定亚洲人群中WPFCs的当前管理趋势以及这些方式的治疗结果。
在这项回顾性分析中，对2013年至2016年在泰国曼谷朱拉隆功国王纪念医院诊断为胰腺炎的所有患者进行了分析。回顾了所有胰腺周围积液（PFCs）患者的相关临床资料。临床成功定义为引流后症状改善。
在636例胰腺炎患者中，72例（11.3%）有WPFCs，其中55例（8.6%）为胰腺假性囊肿（PP），17例（2.7%）为包裹性坏死（WON）。WPFCs最常见的病因是酒精（38.9%）和胆结石（29.2%）。分别有8.3%和6.9%的患者存在术后和胰腺肿瘤相关胰腺炎。PP在慢性胰腺炎（27.8%）中比急性胰腺炎（5.5%）中更常见。在72例WPFCs患者中，31例（43.1%）有局部并发症。采用支持治疗、内镜引流、经皮引流和手术引流的比例分别为58.3%、27.8%、8.3%和5.6%，成功率分别为100%、100%、50%和100%。经皮引流后出现的并发症包括穿刺部位出血（=1例）、PFC感染（=1例）和胰管渗漏（=1例）。
在过去几年中，内镜引流已成为WPFCs最常用的引流途径，其次是经皮引流和手术引流。内镜引流的成功率优于经皮引流，与手术方式相当。
