Pfaffenbach B, Langer M, Stabenow-Lohbauer U, Lux G
Medizinische Klinik 1, Städtisches Klinikum Solingen.
Dtsch Med Wochenschr. 1998 Nov 27;123(48):1439-42. doi: 10.1055/s-2007-1024199.
Endoscopic drainage of a pancreatic pseudocyst is an alternative to surgical intervention. But transmural drainage carries the risk of bleeding or perforation. Effectiveness and complication rate of endoscopic ultrasound-guided drainage, to avoid these risks, was investigated.
Eleven patients (eight men, three women; mean age 55 years) with a pancreatic pseudocyst (nine with alcoholic and two with biliary pancreatitis) were studied prospectively between 1996 and 1998. In all of them transpapillary drainage of the cyst had not been technically possible. After an endoscopic ultrasound (EUS) examination, the gastric wall was incised with a fistulotome under EUS guidance. A guide-wire was then advanced through the fistulotome into the pseudocyst. A double pigtail catheter was implanted for drainage. The size of the pseudocyst was monitored sonographically at two-week intervals.
A cystogastrostomy was successfully established in ten of the twelve patients without serious complication. The pseudocyst was no longer demonstrated after a mean of 4.2 months (2 weeks to 6 months), while a small pseudocyst (1.6 cm [0.9-2.4 cm) remained in three patients. In two of the latter the size of the pseudocyst increased again after removal of the drainage catheter. Complete drainage by repeat cystogastrostomy succeeded in one of them, while a cystojejunostomy was established in the other.
Endoscopic ultrasound-guided transgastric drainage of a pancreatic pseudocyst is an effective treatment with few complications.
胰腺假性囊肿的内镜引流是手术干预的一种替代方法。但经壁引流存在出血或穿孔的风险。本研究旨在探讨内镜超声引导下引流的有效性及并发症发生率，以避免这些风险。
1996年至1998年对11例胰腺假性囊肿患者（8例男性，3例女性；平均年龄55岁）进行了前瞻性研究，其中9例由酒精性胰腺炎引起，2例由胆源性胰腺炎引起。所有患者经乳头囊肿引流在技术上均不可行。在内镜超声（EUS）检查后，在EUS引导下用瘘管刀切开胃壁。然后将导丝通过瘘管刀推进到假性囊肿内。植入双猪尾导管进行引流。每隔两周通过超声检查监测假性囊肿的大小。
12例患者中有10例成功建立了囊肿胃造口术，无严重并发症。平均4.2个月（2周 - 6个月）后假性囊肿消失，3例患者仍残留一个小的假性囊肿（1.6 cm [0.9 - 2.4 cm]）。后3例中的2例在拔除引流导管后假性囊肿大小再次增大。其中1例通过重复囊肿胃造口术成功实现完全引流，另1例则进行了囊肿空肠吻合术。
内镜超声引导下经胃引流胰腺假性囊肿是一种有效的治疗方法，并发症较少。
