Baron T H, Thaggard W G, Morgan D E, Stanley R J
Department of Medicine, University of Alabama at Birmingham, USA.
Gastroenterology. 1996 Sep;111(3):755-64. doi: 10.1053/gast.1996.v111.pm8780582.
BACKGROUND & AIMS: The treatment of patients with extensive pancreatic necrosis remains controversial; a subpopulation of patients with extensive acute pancreatic necrosis develop complex, organized collections. This study examined the feasibility of endoscopic drainage in patients with extensive organized pancreatic necrosis.
Eleven patients with organized pancreatic necrosis (8 sterile and 3 infected) after severe acute necrotizing pancreatitis underwent attempted endoscopic drainage. Dynamic contrast-enhanced computerized tomography showed > or = 50% pancreatic necrosis in 10 of 11 patients in whom endoscopic drainage was performed. In 8 patients, an intrapancreatic nasobiliary lavage catheter was placed into the collection concurrently with 10F stents.
Complete resolution was achieved nonoperatively in 9 patients. At a mean follow-up of 12 months, 1 patient developed a pseudocyst, which was successfully drained endoscopically. Complications occurred in 5, including bleeding that precluded entry into one collection.
Endoscopic therapy may be a viable management option for a subset of patients who remain symptomatic after an episode of acute pancreatic necrosis after the necrosis has become organized and partially liquefied. Intrapancreatic lavage catheter placement is essential to the success of this procedure. Further evaluation of this technique is needed before this method can be adopted into clinical practice.
广泛胰腺坏死患者的治疗仍存在争议；部分广泛急性胰腺坏死患者会形成复杂的、有组织的积液。本研究探讨了内镜引流在广泛有组织胰腺坏死患者中的可行性。
11例严重急性坏死性胰腺炎后出现有组织胰腺坏死的患者（8例无菌性，3例感染性）接受了内镜引流尝试。动态对比增强计算机断层扫描显示，11例接受内镜引流的患者中有10例胰腺坏死≥50%。8例患者在放置10F支架的同时，将胰内鼻胆管冲洗导管置入积液处。
9例患者非手术治愈。平均随访12个月时，1例患者出现假性囊肿，经内镜成功引流。5例出现并发症，包括1例因出血而无法进入一处积液处。
对于急性胰腺坏死发作后坏死已形成组织并部分液化但仍有症状的部分患者，内镜治疗可能是一种可行的治疗选择。胰内冲洗导管的放置是该手术成功的关键。在该方法应用于临床实践之前，需要对其进行进一步评估。
