中国实用外科杂志

中国实用外科杂志

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ERCP辅助治疗胰体尾切除术后胰瘘8例报告

吴文广a，张文杰a，顾    钧a，赵铭宁a，梅佳玮a，陶怡菁b，刘颖斌a，王雪峰a   

  1. 上海交通大学医学院附属新华医院 a.普外科 上海交通大学医学院胆道疾病研究所 b.临床营养科，上海 200092
  • 出版日期:2014-11-01 发布日期:2014-10-31

  • Online:2014-11-01 Published:2014-10-31

摘要：

目的    探讨内镜逆行胰胆管造影（ERCP）辅助治疗胰体尾切除术后胰瘘的疗效。 方法    回顾性分析上海交通大学医学院附属新华医院普外科2010年11月至2014年2月间行胰体尾切除术后因胰瘘相关症状而采用ERCP辅助治疗的8例病人临床资料，并分析其术后疗效。结果    8例病人在ERCP下均见胰腺主胰管有明显的造影剂外渗出，均行胰管支架置入术，支架置入距手术日的平均时间为15.8（9～26）d，ERCP术后胰瘘愈合时间平均为16.0（12～25）d。所有病人的胰管支架在出院3个月后拔除，支架拔除后无胰瘘复发病例。治疗期间均未发生胰腺炎、穿孔及其他并发症。结论    对常规方法无效的胰体尾切除合并胰瘘病人，ERCP辅助行胰管支架置入可改善治疗效果。

关键词: 胰体尾切除术, 胰瘘, 内镜逆行胰胆管造影, 胰管支架

Abstract:

Clinical application of endoscopic retrograde cholangiopancreatography in the treatment of pancreatic fistula after distal pancreatectomy: A report of 8 cases        WU Wen-guang*，ZHANG Wen-jie，GU Jun，et al. *Department of General Surgery，Institute of Biliary Tract Disease，Xinhua Hospital，Affiliated to Shanghai Jiao Tong University School of Medicine，Shanghai 200092，China
Corresponding author：WANG Xue-feng，E-mail：wxxfd@live.cn
Abstract    Objective    To evaluate the role of endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of pancreatic fistula after distal pancreatectomy. Methods    A retrospective review of 8 cases with ongoing symptoms related to the pancreatic fistula after distal pancreatectomy was conducted from November 2010 to February 2014 at Department of General Surgery and Laboratory of General Surgery，Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. Results    ERCP was performed and demonstrated clear extravasation of contrast from the main pancreas duct at the site of pancreas transection in all eight cases. Pancreatic duct stents were placed in all patients at a median time of 15.8 days (range，9-26 days)postoperation and the pancreatic fistula resolved in all patients after a median duration of 16.0 days(range，12-25 days) from the index ERCP. Pancreatic duct stent were removed in all patients three months after discharge，and no patient has developed recurrent pancreatic fistula after stent removal. There was no episodes of pancreatitis，perforation，or other complications associated with pancreatic duct stent placement or removal. Conclusion    ERCP with pancreatic duct stent may have a beneficial role in the management of patients with pancreatic fistula after distal pancreatectomy and the approach should be considered in patients not responsive to traditional management strategies.

Key words: distal pancreatectomy, pancreatic fistula, endoscopic retrograde cholangiopancreatography, pancreatic duct stent