超声内镜引导下胰管引流的临床疗效分析（含视频）

Therapeutic value of endoscopic ultrasound⁃guided pancreatic duct drainage (with video)

摘要:

目的 探讨超声内镜引导下胰管引流术（endoscopic ultrasound⁃guided pancreatic duct drainage，EUS⁃PD）的有效性及安全性。方法 回顾性分析南京大学医学院附属鼓楼医院2018年6月至2022年7月期间因内镜逆行胰管造影术（endoscopic retrograde pancreatography，ERP）失败、效果不佳或解剖结构改变无法行常规ERP治疗而接受EUS⁃PD的16例患者资料，分析EUS⁃PD治疗的完成情况（技术成功）、治疗效果（临床成功）以及不良事件发生情况。结果 纳入的16例患者中，男14例、女2例，年龄（50.69±12.95）岁。共行19例次EUS⁃PD，其中3例次行辅助对接的ERP，15例次行EUS引导下胰管支架置入，1例次行EUS引导下鼻胰管置入术。19例次治疗中84.21%（16/19）实现技术成功，技术成功患者中93.75%（15/16）得到临床成功。术后总体不良事件发生率52.63%（10/19），腹痛47.37%（9/19），发热15.79%（3/19），术后胰腺炎15.79%（3/19）。不良反应均经保守后好转，无原发病或手术相关的死亡。中位随访17.6（8.2，22.3）个月，93.75%（15/16）的患者得到随访，成功行EUS⁃PD的患者中，76.92%（10/13）的患者未再发生腹痛症状。结论 EUS⁃PD对于ERP失败、效果不佳或解剖结构改变的胰腺疾病是一种安全、有效的替代治疗方式。

Abstract:

Objective To explore the effectiveness and safety of endoscopic ultrasound-guided pancreatic duct drainage (EUS-PD). Methods A retrospective analysis was conducted on data of 16 patients who underwent EUS-PD because of endoscopic retrograde pancreatography (ERP) failure, poor effectiveness or anatomical changes and couldn""t undergo the routine ERP in Nanjing Drum Tower Hospital from June 2018 to July 2022. The technical success of EUS-PD, clinical efficacy and post-procedure adverse events were analyzed. Results In the 16 patients, there were 14 males and 2 females, with age of 50.69±12.95 years. A total of 19 times of EUS-PD operations were included, 3 of them were rendezvous-assisted endoscopic retrograde pancreatography (RV-ERP), 15 transgastric or transenteric EUS-guided stent placement and 1 was EUS-guided nasopancreatic duct placement. Technical success was achieved in 84.21% (16/19) patients, and among whom 93.75% (15/16) achieved clinical success. The overall incidence of postoperative adverse events was 52.63% (10/19) including 47.37% (9/19) abdominal pain, 15.79% (3/19) fever and 15.79% (3/19) postoperative pancreatitis. All adverse effects were relieved after general conservative treatment and no primary disease or surgery-related death occurred. The mean follow-up was 17.6 (8.2,22.3) months and 93.75% (15/16) of the patients were followed up. By the time of follow-up, 76.92% (10/13) of the patients who had successfully received EUS-PD had no recurrence of abdominal pain or distension. Conclusion EUS-PD is a safe and effective alternative therapy for those with pancreatic diseases with ERP failure, poor efficacy or anatomical changes.