Binmoeller K F, Seifert H, Walter A, Soehendra N
Department of Endoscopic Surgery, University Hospital Eppendorf, Hamburg, Germany.
Gastrointest Endosc. 1995 Sep;42(3):219-24. doi: 10.1016/s0016-5107(95)70095-1.
Endoscopic drainage of pseudocysts using the transpapillary and transmural approaches has been reported. We evaluated endoscopic drainage in 53 patients with symptomatic pancreatic pseudocysts in whom conservative management had failed.
After preliminary endoscopic retrograde pancreatography, transpapillary drainage was attempted in 33 patients with pseudocysts that communicated with the main pancreatic duct. Transmural drainage of pseudocysts in contact with the stomach or duodenal wall was attempted in the remaining 20 patients and in 4 patients selected for combined transpapillary and transmural drainage. The cause of pseudocysts was chronic pancreatitis in 92%. The median pseudocyst size was 7.0 cm (range, 2 to 16).
Endoscopic drainage was technically successful in 50 patients (94%), of whom 47 had complete pseudocyst resolution. Complications occurred in 11% and included gallbladder puncture (n = 1) and bleeding (n = 2) after transmural drainage, and pancreatitis (n = 1) after transpapillary drainage; stent clogging resulted in abscess formation in 2 patients. Mean follow-up was 22 months (range, 1 to 70); pseudocysts recurred in 11 patients (23%), of whom 7 were successfully re-treated endoscopically.
Both transpapillary and transmural pseudocyst drainage are highly effective in patients with pseudocysts demonstrating suitable anatomy for these endoscopic techniques.
已有经乳头和经壁途径内镜下引流假性囊肿的报道。我们评估了53例症状性胰腺假性囊肿且保守治疗失败患者的内镜下引流情况。
在初步内镜逆行胰胆管造影后，对33例假性囊肿与主胰管相通的患者尝试经乳头引流。对其余20例与胃或十二指肠壁接触的假性囊肿患者以及4例选择经乳头和经壁联合引流的患者尝试经壁引流。92%的假性囊肿病因是慢性胰腺炎。假性囊肿的中位大小为7.0 cm（范围2至16 cm）。
50例患者（94%）内镜下引流技术成功，其中47例假性囊肿完全消退。并发症发生率为11%，包括经壁引流后胆囊穿刺（1例）和出血（2例），以及经乳头引流后胰腺炎（1例）；支架堵塞导致2例患者形成脓肿。平均随访22个月（范围1至70个月）；11例患者（23%）假性囊肿复发，其中7例经内镜再次成功治疗。
对于假性囊肿解剖结构适合这些内镜技术的患者，经乳头和经壁假性囊肿引流均非常有效。
