透壁穿刺与经乳头引流对胰管断裂综合征的远期疗效观察

Long‑term efficacy of transmural and transpapillary drainage for disconnected pancreatic duct syndrome

摘要:

目的 探讨3种内镜治疗方式（透壁穿刺引流、经乳头胰管支架引流及联合引流）对胰管断裂综合征复发的影响。方法 收集2018年1月至2022年12月北京协和医院消化内科收治的确诊为胰管断裂综合征并行内镜下治疗的患者22例。通过回顾患者病历资料以及对患者进行电话随访，记录患者的临床特征、影像学特征、引流方式、并发症、治疗效果等。结果 22例患者共有27例次内镜治疗事件，根据操作方式分为3组：囊肿透壁穿刺引流组11例次，经乳头胰管支架引流组8例次，联合引流组8例次。联合引流组引流成功率100.0%（8/8），明显高于经乳头胰管支架引流组的50.0%（4/8）（P=0.012），但与透壁穿刺引流组的90.9%（10/11）相比，差异无统计学意义（P=0.621）。联合引流组的1年复发率0.0%（0/8），显著低于单纯透壁穿刺引流组的55.6%（5/9）（P=0.018），而且低于经乳头胰管支架引流组的42.9%（3/7），但差异无统计学意义（P=0.085）。3组的临床症状缓解率分别为45.5%（5/11）、75.0%（6/8）和87.5%（7/8），差异无统计学意义（H=3.890，P=0.143），操作并发症发生率分别为54.5%（6/11）、75.0%（6/8）和25.0%（2/8），差异无统计学意义（H=3.909，P=0.142）。结论 囊肿透壁穿刺引流联合胰管支架置入可在短期内获得满意的囊液引流效果，并显著减少1年复发。

Abstract:

Objective To assess the efficacy of endoscopic transmural drainage, transpapillary drainage and their combination in reducing cyst recurrence in patients with disconnected pancreatic duct syndrome (DPDS). Methods A retrospective study was conducted involving 22 patients diagnosed as having DPDS in Peking Union Medical College Hospital from January 2018 to December 2022. Patient data including clinical information, imaging characteristics, drainage technique, complications, and outcomes were extracted from the medical records and telephone follow-up. Results There were 27 endoscopic treatments in 22 patients, which were categorized into 3 groups based on the procedural approach: transmural in 11 cases, transpapillary in 8, and the combination of both in 8. The combined drainage group exhibited a significantly higher drainage success rate (100.0%, 8/8) compared with the transpapillary group (50.0%, 4/8, P=0.012), with no significant difference compared with the transmural group [90.9% (10/11), P=0.621]. The one-year recurrence rate was significantly lower in the combined drainage group [0.0% (0/8)] than that in the transmural drainage group [55.6% (5/9), P=0.018], and transpapillary drainage alone [42.9% (3/7)] though it did not reach significance (P=0.085). No significant differences were observed in treatment success rate [45.5% (5/11), 75.0% (6/8) and 87.5% (7/8), H=3.890, P=0.143], or complication incidence [54.5% (6/11), 75.0% (6/8) and 25.0% (2/8), H=3.909, P=0.142]. Conclusion Transmural drainage combined with pancreatic duct stent placement results in satisfactory drainage of cystic fluid in the short term and significantly reduces one-year recurrence among patients with DPDS.