Binmoeller K F, Jue P, Seifert H, Nam W C, Izbicki J, Soehendra N
Department of Endoscopic Surgery, University Hospital Eppendorf, Hamburg, Germany.
Endoscopy. 1995 Nov;27(9):638-44. doi: 10.1055/s-2007-1005780.
Endoscopic pancreatic stent drainage has been reported to relieve pain due to chronic pancreatitis in patients with ductal outflow obstruction. However, data regarding the long-term results, as presented here, have hitherto been lacking.
Over a nine-year period, 93 patients (65 males, mean age 49 years) with narcotic-dependent pain due to chronic pancreatitis and with a dominant pancreatic duct stricture visualized by endoscopic retrograde cholangiopancreatography (ERCP), were treated by stent drainage. The duration of pain prior to treatment averaged 5.6 years. The stents were exchanged according to symptoms, and removed if the stricture was judged to be adequately dilated after stenting.
Sixty-nine patients (74%) reported complete (n = 46) or partial (n = 23) pain relief at six months. In this group of "early responders", 60 patients experienced sustained improvement during a mean follow-up of 4.9 years (nine had recurrent pain after a mean of 1.2 years). Stents were removed in 49 patients after a mean of 15.7 months; during a mean follow-up of 3.8 years, 36 patients remained pain-free, and 13 had a relapse of pain (11 were retreated by endoscopic drainage and subsequently became pain-free). Complications seen included mild pancreatitis (n = 4) and abscess formation secondary to stent clogging (n = 2). Most patients experienced a regression of the ductal dilation after stenting.
In selected patients, early responders to pancreatic stent drainage are likely to benefit over the long term. Stent removal after stricture dilation may be associated with continued pain relief.
内镜下胰管支架引流术已被报道可缓解因慢性胰腺炎伴导管流出道梗阻患者的疼痛。然而，如下文所示的长期结果数据此前一直缺乏。
在九年期间，93例（65例男性，平均年龄49岁）因慢性胰腺炎导致依赖麻醉性镇痛药的疼痛且经内镜逆行胰胆管造影（ERCP）显示主胰管狭窄的患者接受了支架引流治疗。治疗前疼痛持续时间平均为5.6年。根据症状更换支架，若支架置入后狭窄被判定已充分扩张则取出支架。
69例患者（74%）在6个月时报告疼痛完全缓解（n = 46）或部分缓解（n = 23）。在这组“早期反应者”中，60例患者在平均4.9年的随访期间病情持续改善（9例在平均1.2年后出现复发性疼痛）。49例患者在平均15.7个月后取出支架；在平均3.8年的随访期间，36例患者保持无痛，13例出现疼痛复发（11例经内镜引流再次治疗后随后无痛）。观察到的并发症包括轻度胰腺炎（n = 4）和支架堵塞继发脓肿形成（n = 2）。大多数患者在支架置入后胰管扩张有所减轻。
在选定的患者中，胰管支架引流的早期反应者可能长期受益。狭窄扩张后取出支架可能与持续的疼痛缓解相关。
