He Yong-Gang, Li Jing, Peng Xue-Hui, Wu Jing, Xie Ming-Xun, Tang Yi-Chen, Zheng Lu, Huang Xiao-Bing
Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, China.
Department of Radiology, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, China.
World J Clin Cases. 2021 Aug 6;9(22):6254-6267. doi: 10.12998/wjcc.v9.i22.6254.
Endoscopic retrograde pancreatic drainage (ERPD) and stent implantation has become the major treatment method for pancreatic pseudocysts. However, it is associated with a high recurrence rate and infection.
To manage pancreatic pseudocysts by sequential therapy with endoscopic naso-pancreatic drainage (ENPD) combined with ERPD and evaluate the treatment outcome.
One hundred and sixty-two cases of pancreatic pseudocyst confirmed by endoscopic examination at our hospital between January 2014 and January 2020 were retrospectively analyzed. There were 152 cases of intubation the duodenal papilla, of which 92 involved pancreatic duct stent implantation and 60 involved sequential therapy with combined ENPD and ERPD (two-step procedure). The success rate of the procedure, incidence of complications (infection, bleeding, .), recurrence, and length and cost of hospitalization were compared between the two groups.
The incidence of infection was significantly higher in the ERPD group (12 cases) than in the two-step procedure group (2 cases). Twelve patients developed infection in the ERPD group, and anti-infection therapy was effective in five cases but not in the remaining seven cases. Infection presented as fever and chills in the two-step procedure group. The reoperation rate was significantly higher in the ERPD group with seven cases compared with zero cases in the two-step procedure group ( < 0.05). Similarly, the recurrence rate was significantly higher in the ERPD group (19 cases) than in the two-step procedure group (0 cases).
Sequential therapy with combined ENPD and ERPD is safe and effective in patients with pancreatic pseudocysts.
内镜逆行胰管引流（ERPD）及支架植入术已成为治疗胰腺假性囊肿的主要方法。然而，该方法复发率高且易引发感染。
采用内镜鼻胰管引流（ENPD）联合ERPD序贯治疗胰腺假性囊肿并评估治疗效果。
回顾性分析2014年1月至2020年1月在我院经内镜检查确诊的162例胰腺假性囊肿患者。其中152例行十二指肠乳头插管，92例行胰管支架植入，60例行ENPD联合ERPD序贯治疗（两步法）。比较两组手术成功率、并发症发生率（感染、出血等）、复发率以及住院时间和费用。
ERPD组感染发生率（12例）显著高于两步法组（2例）。ERPD组12例发生感染，抗感染治疗5例有效，其余7例无效。两步法组感染表现为发热、寒战。ERPD组再次手术率显著高于两步法组，分别为7例和0例（P<0.05）。同样，ERPD组复发率（19例）显著高于两步法组（0例）。
ENPD联合ERPD序贯治疗胰腺假性囊肿患者安全有效。
