Catalano M F, Geenen J E, Schmalz M J, Johnson G K, Dean R S, Hogan W J
Pancreatic Biliary Center, St Luke's Medical Center, Milwaukee, Wisconsin, USA.
Gastrointest Endosc. 1995 Sep;42(3):214-8. doi: 10.1016/s0016-5107(95)70094-3.
Endoscopic treatment of pancreatic pseudocysts via cystenterostomy has been recognized as a successful treatment option in carefully selected patients. Pancreatic transpapillary stenting as an alternative treatment option in patients with pancreatic pseudocysts directly communicating with the main duct has received little consideration. The aim of the current study was to assess the safety and utility of transpapillary pancreatic endoprosthesis in the treatment of communicating pseudocysts.
Twenty-one patients underwent placement of 33 transpapillary endoprostheses for the treatment of symptomatic pancreatic pseudocysts. All pseudocysts communicated with the main pancreatic duct and ranged in size from 3 to 9 cm (mean 6 cm). Eight patients had associated pancreatic duct strictures.
Stent placement was successful in all cases: 13 directly into the pseudocyst, 8 beyond the stricture but not into the pseudocyst. Initial resolution of pseudocysts was seen in 17 patients, with 16 patients free of pseudocyst recurrence at mean follow-up of 37 months. All patients with associated strictures were treated successfully. Factors predictive of success included presence of strictures, size of pseudocyst greater than or equal to 6 cm, location in the body of the pancreas, and duration of pseudocyst less than 6 months. Complications included one episode of mild pancreatitis.
Endoscopic treatment of symptomatic pancreatic pseudocysts with ductal communication by transpapillary pancreatic duct stenting is a safe, effective modality and should be considered a first line therapy.
通过囊肿肠吻合术对胰腺假性囊肿进行内镜治疗已被公认为是在精心挑选的患者中的一种成功治疗选择。胰管经乳头支架置入术作为胰腺假性囊肿与主胰管直接相通患者的一种替代治疗选择，很少受到关注。本研究的目的是评估经乳头胰内支架在治疗交通性假性囊肿中的安全性和实用性。
21例患者接受了33个经乳头内支架置入术以治疗有症状的胰腺假性囊肿。所有假性囊肿均与主胰管相通，大小在3至9厘米之间（平均6厘米）。8例患者伴有胰管狭窄。
所有病例支架置入均成功：13例直接置入假性囊肿，8例越过狭窄但未置入假性囊肿。17例患者假性囊肿最初消退，16例患者在平均37个月的随访中无假性囊肿复发。所有伴有狭窄的患者均成功治疗。成功的预测因素包括存在狭窄、假性囊肿大小大于或等于6厘米、位于胰体部以及假性囊肿持续时间小于6个月。并发症包括1次轻度胰腺炎发作。
经乳头胰管支架置入术内镜治疗有导管相通的有症状胰腺假性囊肿是一种安全、有效的方法，应被视为一线治疗方法。
