Elton E, Howell D A, Parsons W G, Qaseem T, Hanson B L
Division of Gastroenterology, Maine Medical Center, Portland, USA.
Gastrointest Endosc. 1998 Mar;47(3):240-9. doi: 10.1016/s0016-5107(98)70320-7.
Endoscopic pancreatic sphincterotomy is less widely practiced than biliary sphincterotomy, in part because of the lack of firm data regarding its indications and safety. In addition, recent reports of ductal and parenchymal changes occurring after pancreatic stenting raise concerns about the standard practice of stent placement at the time of pancreatic sphincterotomy. We report our experience with pancreatic sphincterotomy and describe the use of a technique involving overnight nasopancreatic drainage rather than stenting.
We reviewed the records of the 164 pancreatic sphincterotomies performed on 160 patients at our institution between January 1, 1991, and October 1, 1996, comparing procedures done with overnight nasopancreatic catheter placement with those done with stenting or no drainage. We also examined the long-term clinical outcome of patients after pancreatic sphincterotomy.
Of the 164 sphincterotomies, 98 were done with overnight nasopancreatic drainage, 50 with stent placement, and 16 with no drainage. Complications (all pancreatitis) were significantly more frequent in the group with no drainage (12.5%) as compared with those with drainage (0.7%); p < 0.003. Nasopancreatic drainage was as safe as stent placement, with no complications after 98 procedures. Pancreatic sphincterotomy was effective when used as primary therapy, with 64% of patients so treated experiencing complete and long-lasting resolution of symptoms after the procedure.
Pancreatic sphincterotomy is safe and effective, although pancreatic drainage is required to reduce the incidence of pancreatitis. Overnight nasopancreatic drainage is the method of choice, as it carries as low a complication rate as stent placement, but without the need for a repeat procedure, and presumably without the risk of ductal and parenchymal damage.
内镜下胰管括约肌切开术的应用不如胆管括约肌切开术广泛，部分原因是缺乏关于其适应证和安全性的确切数据。此外，最近有关胰管支架置入术后出现导管和实质改变的报道，引发了人们对胰管括约肌切开术时支架置入标准操作的担忧。我们报告了我们在胰管括约肌切开术方面的经验，并描述了一种采用过夜鼻胰管引流而非支架置入的技术。
我们回顾了1991年1月1日至1996年10月1日期间在本机构为160例患者施行的164例胰管括约肌切开术的记录，比较了采用过夜鼻胰管置管的手术与采用支架置入或不进行引流的手术。我们还检查了胰管括约肌切开术后患者的长期临床结局。
在164例括约肌切开术中，98例采用过夜鼻胰管引流，50例采用支架置入，16例未进行引流。与进行引流的组（0.7%）相比，未进行引流的组（12.5%）并发症（均为胰腺炎）的发生率明显更高；p<0.003。鼻胰管引流与支架置入一样安全，98例手术后均无并发症。胰管括约肌切开术作为主要治疗方法是有效的，接受该治疗的患者中有64%在术后症状得到完全且持久的缓解。
胰管括约肌切开术是安全有效的，尽管需要进行胰管引流以降低胰腺炎的发生率。过夜鼻胰管引流是首选方法，因为它的并发症发生率与支架置入一样低，但无需重复操作，而且可能没有导管和实质损伤的风险。
