在有包裹性胰腺坏死（WOPN）的经壁引流过程中，在荧光透视引导下进行内镜坏死组织清除术。

Endoscopic necrosectomy under fluoroscopic guidance during transmural drainage of walled-off pancreatic necrosis (WOPN).

作者信息

Jagielski Mateusz, Smoczyński Marian, Adrych Krystian, Sztuczka Ewa, Jackowski Marek

机构信息

Katedra i Klinika Chirurgii Ogólnej, Gastroenterologicznej i Onkologicznej, Collegium Medicum, Uniwersytet im. Mikołaja Kopernika w Toruniu.

Katedra i Klinika Gastroenterologii i Hepatologii, Gdański Uniwersytet Medyczny.

出版信息

Pol Przegl Chir. 2019 Nov 13;92(1):12-17. doi: 10.5604/01.3001.0013.5610.

DOI:10.5604/01.3001.0013.5610

PMID:32312924

Abstract

INTRODUCTION

The endoscopic treatment of walled-off pancreatic necrosis (WOPN) as well as other minimally invasive methods have been evolving since last years.

AIM

The aim of this study is evaluation of efficiency and safety of endoscopic necrosectomy under fluoroscopy done during the transmural drainage in patients with symptomatic WOPN.

MATERIAL AND METHODS

The retrospective analysis 114 consecutive patients with symptomatic WOPN were treated endoscopically in our medical center between 2011 and 2016.

MATERIAL AND METHODS

The retrospective analysis 114 consecutive patients with symptomatic WOPN were treated endoscopically in our medical center between 2011 and 2016.

RESULTS

Endoscopic necrosectomy was performed under fluoroscopic guidance during transmural drainage in 24/114 (21.05%) patients. The mean amount of endoscopic procedures in each patient was 8.88 (3-27). The active drainage was continued averagely for 40.1 (11-96) days. The avarage number of necrosectomy procedures during continued drainage was 6.54 (1-24) per patient. Additional percutaneous drainage was applied in just two patients. The complications of endotherapy were present in 9/24 (37.5%) patients. The therapeutic success was reached in 23/24 (95.83%) patients. The mean time of observation was 35 [18-78] months. The recurrence of pancreatic fluid collection was stated in 4 patients during the observation time. The mean time between the end of endotherapy and recurrence of fluid collection was 19 [16-22] months. In three patients recurrent fluid collections were treated endoscopically and in one patient were treated surgically. Long-term success of endoscopic treatment of WOPN was reached in 22/24 (91.67%) patients.

CONCLUSIONS

Endoscopic necrosectomy under fluoroscopic guidance during transmural drainage is successful and safe method of minimally invasive treatment in selected patients with walled-off pancreatic necrosis.

摘要

引言

自去年以来，壁内胰腺坏死（WOPN）的内镜治疗以及其他微创方法一直在不断发展。

目的

本研究的目的是评估在有症状的WOPN患者经壁引流期间在荧光透视引导下进行内镜坏死组织清除术的有效性和安全性。

材料与方法

回顾性分析2011年至2016年期间在我们医疗中心接受内镜治疗的114例有症状的WOPN连续患者。

结果

在24/114（21.05%）例患者的经壁引流过程中，在荧光透视引导下进行了内镜坏死组织清除术。每位患者的内镜手术平均次数为8.88（3 - 27次）。主动引流平均持续40.1（11 - 96）天。持续引流期间每位患者的坏死组织清除术平均次数为6.54（1 - 24次）。仅2例患者进行了额外的经皮引流。9/24（37.5%）例患者出现了内镜治疗并发症。23/24（95.83%）例患者治疗成功。平均观察时间为35 [18 - 78]个月。观察期间有4例患者出现胰液积聚复发。胰液积聚复发与内镜治疗结束之间的平均时间为19 [16 - 22]个月。3例复发性胰液积聚患者接受了内镜治疗，1例患者接受了手术治疗。22/24（91.67%）例患者内镜治疗WOPN取得长期成功。