内镜下覆膜金属支架置入引流治疗胰腺坏死感染和假性囊肿13例及文献分析

杨歆; 孙玲; 黄其密; 刘璐; 樊超强; 李春花; 林辉; 任成山; 柏健鹰; 杨仕明

doi:10.16016/j.1000-5404.201809017

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内镜下覆膜金属支架置入引流治疗胰腺坏死感染和假性囊肿13例及文献分析

临床医学 | 更新时间：2026-01-09

- 内镜下覆膜金属支架置入引流治疗胰腺坏死感染和假性囊肿13例及文献分析
- Endoscopic ultrasound-guided drainage using lumen-apposing fully covered, self-expandable metal stent for treatment of infected pancreatic necrosis and pseudocyst: analysis of 13 cases and literature review
- 第三军医大学学报 2019年41卷第2期页码：137-142
- 作者机构：
  
  400037 重庆，陆军军医大学(第三军医大学)第二附属医院消化内科
- 作者简介：
  
  [ 樊超强，E-mail: fcqxhkwjs@126.com FAN Chaoqiang, E-mail: fcqxhkwjs@126.com
- 基金信息：
  
  第三军医大学新桥医院临床科研项目(2014YLC15)
- DOI：10.16016/j.1000-5404.201809017
  中图分类号： R181.23
- 收稿：2018-09-03，
  
  修回：2018-11-13，
  
  纸质出版：2019-01-30
- 稿件说明：
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杨歆, 孙玲, 黄其密, 等. 内镜下覆膜金属支架置入引流治疗胰腺坏死感染和假性囊肿13例及文献分析[J]. 第三军医大学学报, 2019,41(2):137-142.

Xin YANG, Ling SUN, Qimi HUANG, et al. Endoscopic ultrasound-guided drainage using lumen-apposing fully covered, self-expandable metal stent for treatment of infected pancreatic necrosis and pseudocyst: analysis of 13 cases and literature review[J]. Journal of Third Military Medical University, 2019, 41(2): 137-142.
杨歆, 孙玲, 黄其密, 等. 内镜下覆膜金属支架置入引流治疗胰腺坏死感染和假性囊肿13例及文献分析[J]. 第三军医大学学报, 2019,41(2):137-142. DOI： 10.16016/j.1000-5404.201809017.

Xin YANG, Ling SUN, Qimi HUANG, et al. Endoscopic ultrasound-guided drainage using lumen-apposing fully covered, self-expandable metal stent for treatment of infected pancreatic necrosis and pseudocyst: analysis of 13 cases and literature review[J]. Journal of Third Military Medical University, 2019, 41(2): 137-142. DOI： 10.16016/j.1000-5404.201809017.

摘要

目的

探讨内镜下覆膜金属支架置入引流治疗胰腺坏死感染(infected pancreatic necrosis

IPN)和胰腺假性囊肿(pancreatic pseudocyst

PPC)的有效性、可行性和安全性。

方法

选取2012-2017年我科收治的IPN、PPC并进行覆膜金属支架置入引流治疗的13例患者。计算机检索同期中国知网、万方数据库、维普网、Cochrane Library、PubMed、Web of Science等数据库收录的公开发表的内镜下覆膜金属支架置入引流治疗IPN和PPC患者文献数据，最终选取12篇文献，纳入IPN 193例，PPC 138例，对覆膜金属支架置入引流治疗IPN和PPC的疗效进行分析。

结果

我科13例患者(IPN 12例，PPC 1例)支架置入成功率100%(13/13)，救治成功率92.3%(12/13)，1例(7.7%)患者因感染严重及脓腔出血死亡；未发生支架移位、脓(囊)腔破裂穿孔、堵管，术后并发肺部感染者6例(46.2%)，平均住院时间为44.8(9~153)d。12篇文献共纳入331例患者(193例IPN、138例PPC)，救治成功率98.5%(326/331)，死亡率1.5%(5/331)。本研究和文献报道共计344例(206例IPN，138例PPC)患者，手术成功率100%(344/344)，救治成功率98.3%(338/344)，死亡率1.7%(6/344)；发生支架移位13例(3.8%)，术后出血11例(3.2%)，堵管3例(0.9%)，穿孔1例(0.3%)，伴肺部感染及泌尿系感染19例(5.5%)。

结论

内镜下覆膜金属支架置入引流治疗IPN和PPC手术成功率较高，临床疗效较好，并发症少，死亡率低。

Abstract

Objective

To investigate the feasibility

efficacy and safety of endoscopic ultrasound (EUS)-guided drainage of peripancreatic fluid collection (PFC) using lumen-apposing fully covered

self-expandable metal stent (LAMS) for treatment of infected pancreatic necrosis (IPN) and pancreatic pseudocyst (PPC).

Methods

We retrospectively analyzed the data of 13 patients (including 11 male and 2 female patients

mean age 42.6±12.1 years) with IPN (12 cases) or PPC (1 case) treated with EUS-guided drainage of PFC using LAMS in our department from January

2012 to December

2017. We also searched China National Knowledge Infrastructure (CNKI)

Wanfang Database

VIP Database Network

Cochrane Library

Pubmed

and Web of Science for relevant studies to analyze the efficacy and safety of LAMS in the treatment of IPN and PPC.

Results

Stent placement was successful in all the 13 patients treated in our department. Twelve (92.3%) of the patients were cured

and 1 (7.7%) died for severe infection and intra-abscess hemorrhage. None of the patients experienced stent displacement

abscess or cyst cavity rupture (or perforation)

or drainage tube occlusion. Six (46.2%) of the patients had pulmonary infections after the operation. The mean length of hospital stay of the patients was 44.8 d (range 9-153 d). We retrieved 12 relevant studies from the databases involving a total of 331 patients (193 with IPN and 138 with PPC)

among whom 326 (98.5%) were successfully treated and 5 (1.5%) died. In the total of 344 cases after combining our cases with the reported cases (including 206 patients with IPN and 138 with PPC)

the success rate of LAMS surgery was 100%

the cure rate was 98.3% (338 cases)

and the mortality rate was 1.7% (6 cases); stent displacement occurred in 13 cases (3.8%)

postoperative bleeding in 11 cases (3.2%)

stent occlusion in 3 cases (0.9%)

postoperative abscess perforation in 1 case (0.3%)

and postoperative with lung and urinary tract infections in 19 cases (5.5%).

Conclusion

EUS-guided drainage of PFC using LAMS has a high success rate for treatment of IPN and PPC and achieves good clinical outcomes with a low incidence of complications and a low mortality rate of the patients.

关键词

Keywords

references

黄耿文, 申鼎成, 亢浩, 等.微创腹膜后入路胰腺坏死组织清除术治疗感染性胰腺坏死18例疗效分析[J].中国实用外科杂志, 2016, 36(11): 1197-1199.

HUANG G W, SHEN D C, KANG H, et al . Minimally inv asive retroperitoneal approach for pancreatic necrosis in the treatment of 18 cases of infectious pancreatic necrosis[J ] . Chin J Pract Med, 2016, 36(11): 1197-1199. DOI: 10.7504/CJPS.ISSN1005-2208.2016.11.16.

VAN GRINSVEN J, VAN BRUNSCHOT S, BAKKER O J, et al . Diagnostic strategy and timing of intervention in infected necrotizing pancreatitis: an international expert survey and case vignette study[J ] . HPB(Oxford), 2016, 18(1): 49-56. DOI: 10.1016/j.hpb.2015.07.003.

樊超强, 刘恩, 杨歆, 等.内镜清创术与外科清创术治疗胰腺坏死感染的回顾性研究[J].第三军医大学学报, 2017, 39(8): 807-812.

FAN C Q, LIU E, YANG X, et al . Efficacy of endoscopic and surgical necrosectomy for infected pancreatic necrosis: a retrospective study of 68 cases[J ] . J Third Mili Med Univ, 2017, 39(8): 807-812. DOI: 10.16016/j.1000-5404.201612051.

BANKS P A, BOLLEN T L, DERVENIS C, et al . Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus[J ] . Gut, 2013, 62(1): 102-111. DOI: 10.1136/gutjnl-2012-302779.

BARON T H, THAGGARD W G, MORGAN D E, et al . Endoscopic therapy for organized pancreatic necrosis[J ] . Gastroenterology, 1996, 111(3): 755-764. DOI: 10.1053/gast.1996.v111.pm8780582.

朱勇, 何文华, 夏亮, 等.内镜下经胃坏死组织清创术治疗重症急性胰腺炎并包裹性坏死的疗效初探[J].中华消化内镜杂志, 2015, 32(3):187-190.

ZHU Y, HE W H, XIA L, et al . Endoscopic debridement of gastric necrotic tissue in the treatment of severe acute pancreatitis with encapsulated necrosis.[J ] . Chin J Digest Endosc, 2015, 32(3): 187-190. DOI: 10.3760/cma.j.issn.1007-5232.2015.03.013.

Greenberg J A, Hsu J, Bawazeer M, et al . Clinical practice guideline: management of acute pancreatitis[J ] . Can J Surg, 2016, 59(2): 128-140. DOI: 10.1503/cjs.015015.

SIDDIQUI A A, ADLER D G, NIETO J, et al . EUS-guided drainage of peripancreatic fluid collections and necrosis by using a novel lumen-apposing stent: a large retrospective, multicenter U.S. experience (with videos)[J ] . Gastrointest Endosc, 2016, 83(4): 699-707. DOI: 10.1016/j.gie.2015.10.020.

WALTER D, WILL U, SANCHEZ-YAGUE A, et al . A novel lumen-apposing metal stent for endoscopic ultrasound-guided drainage of pancreatic fluid collections: a prospective cohort study[J ] . Endoscopy, 2015, 47(1): 63-67. DOI: 10.1055/s-0034-1378113.

CHANDRAN S, EFTHYMIOU M, KAFFES A, et al . Management of pancreatic collections with a novel endoscopically placed fully covered self-expandable metal stent: a national experience (with videos)[J ] . Gastrointest Endosc, 2015, 81(1): 127-135. DOI: 10.1016/j.gie.2014.06.025.

SHAH R J, SHAH J N, WAXMAN I, et al . Safety and efficacy of endoscopic ultrasound-guided drainage of pancreatic fluid collections with lumen-apposing covered self-expanding metal stents[J ] . Clin Gastroenterol Hepatol, 2015, 13(4): 747-752. DOI: 10.1016/j.cgh.2014.09.047.

PENN D E, DRAGANOV P V, WAGH M S, et al . Prospective evaluation of the use of fully covered self-expanding metal stents for EUS-guided transmural drainage of pancreatic pseudocysts[J ] . Gastrointest Endosc, 2012, 76(3): 679-684. DOI: 10.1016/j.gie.2012.04.457.

ITOI T, BINMOELLER K F, SHAH J, et al . Clinical evaluation of a novel lumen-apposing metal stent for endosonography-guided pancreatic pseudocyst and gallbladder drainage (with videos)[J ] . Gastrointest Endosc, 2012, 75(4): 870-876. DOI: 10.1016/j.gie.2011.10.020.

SARKARIA S, SETHI A, RONDON C, et al . Pancreatic necrosectomy using covered esophageal stents: a novel approach[J ] . J Clin Gastroenterol, 2014, 4 8(2): 145-152. DOI: 10.1097/MCG.0b013e3182972219.

金震东, 蒋斐, 姚瑶, 等.内镜超声引导下经胃穿刺覆膜金属支架引流胰腺假性囊肿的初步临床研究[J].中华消化内镜杂志, 2014, 31(9): 486-488.

JIN Z D, JIANG F, YAO Y, et al . Clinical evaluation of fully covered self-expanding metal stent for endosonograph-guided transgastric pancreatic pseudocyst drainage[J ] . Chin J Digest Endosc, 2014, 31(9): 486- 488. DOI: 10.3760/cma.j.issn.1007-5232.2014.09.002.

ATTAM R, TRIKUDANATHAN G, ARAIN M, et al . Endoscopic transluminal drainage and necrosectomy by using a novel, through-the-scope, fully covered, large-bore esophageal metal stent: preliminary experience in 10 patients[J ] . Gastrointest Endosc, 2014, 80(2): 312-318. DOI: 10.1016/j.gie.2014.02.013.

GORNALS J B, DE LA SERNA-HIGUERA C, SÁNCHEZ-YAGUE A, et al . Endosonography-guided drainage of pancreatic fluid collections with a novel lumen-apposing stent[J ] . Surg Endosc, 2013, 27(4): 1428-1434. DOI: 10.1007/s00464-012-2591-y.

YAMAMOTO N, ISAYAMA H, KAWAKAMI H, et al . Preliminary report on a new, fully covered, metal stent designed for the treatment of pancreatic fluid collections[J ] . Gastrointest Endosc, 2013, 77(5): 809-814. DOI: 10.1016/j.gie.2013.01.009.

SAXENA P, SINGH V K, MESSALLAM A, et al . Resolution of walled-off pancreatic necrosis by EUS-guided drainage when using a fully covered through-the-scope self-expandable metal stent in a single procedure (with video)[J ] . Gastrointest Endosc, 2014, 80(2): 319-324. DOI: 10.1016/j.gie.2014.04.041.

DA COSTA D W, BOERMA D, VAN SANTVOORT H C, et al . Staged multidisciplinary step-up management for necrotizing pancreatitis[J ] . Br J Surg, 2014, 101(1): e65-e79. DOI: 10.1002/bjs.9346.

IAP/APA. evidence-based guidelines for the management of acute pancreatitis[J]. Pancreatology, 2013, 13(4 Suppl 2): e1-15. DOI: 10.1016/j.pan.2013.07.063.

ANTILLON M R, BECHTOLD M L, BARTALOS C R, et al . Transgastric endoscopic necrosectomy with temporary metallic esophageal stent placement for the treatment of infected pancreatic necrosis (with video)[J ] . Gastrointest Endosc, 2009, 69(1): 178-180. DOI: 10.1016/j.gie.2008.03.1066.

PEERY A F, CROCKETT S D, BARRITT A S, et al . Burden of gastrointestinal, liver, and pancreatic diseases in the United States[J ] . Gastroenterology, 2015, 149(7): 1731- 1741.e3. DOI: 10.1053/j.gastro.2015.08.045.

FREEMAN M L, WERNER J, VAN SANTVOORT H C, et al . Interventions for necrotizing pancreatitis: summary of a multidisciplinary consensus conference[J ] . Pancreas, 2012, 41(8): 1176-1194. DOI: 10.1097/MPA.0b013e 318269c660.

VAN SANTVOORT H C, BESSELINK M G, BAKKER O J, et al . A step-up approach or open necrosectomy for necrotizing pancreatitis[J ] . N Engl J Med, 2010, 362(16): 1491-1502. DOI: 10.1056/NEJMoa0908821.

BANG J Y, HASAN M, NAVANEETHAN U, et al . Lumen-apposing metal stents (LAMS) for pancreatic fluid collection (PFC) drainage: may not be business as usual[J ] . Gut, 2017, 66(12): 2054-2056. DOI: 10.1136/gutjnl-2016-312812.

VARADARAJULU S, RANA S S, BHASIN D K. Endoscopic therapy for pancreatic duct leaks and disruptions[J]. Gastrointest Endosc Clin N Am, 2013, 23(4): 863-892. DOI: 10.1016/j.giec.2013.06.008.

BAZERBACHI F, SAWAS T, VARGAS E J, et al . Metal stents versus plastic stents for the management of pancreatic walled-off necrosis: a systematic review and meta-analysis[J ] . Gastrointest Endosc, 2018 , 87(1): 30-42.e15. DOI: 10.1016/j.gie.2017.08.025.

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内镜清创术与外科清创术治疗胰腺坏死感染的回顾性研究