摘要
目的探讨内镜下胆胰管支架置入在胰头导管内乳头状粘液瘤(IPMN)局部切除术中的临床价值。方法回顾分析杭州市第一人民医院2020年1月至2023年1月收治的8例病灶直径小于3.0cm胰头IPMN,经超声内镜(EUS)诊断联合ERCP置入胆胰管支架后行局部切除术患者的临床资料。结果8例患者经CT、MRI诊断:3例位于胰头部,3例位于钩突部,2例位于胰颈部,其中4例合并CA199升高(56.1~105.3kU/L)。EUS瘤体长径1.5~3.0 cm,平均2.3 cm,3例存在壁结节(3.2~6.1 mm)。ERCP置入胆胰管支架顺利,ERCP术后出现高淀粉酶血症3例。8例均行局部切除术,术中冰冻切片均为非浸润性IPMN,切缘阴性。术后发生A级胰瘘1例(12.5%),经保守治疗后恢复,无围术期死亡。患者平均住院时间10.2天(7~14天)。术后病理7例为交界性肿瘤,1例为局灶高级别上皮内瘤变。术后6月拔除胆胰管支架,且均随访半年以上,未见病变复发,无胆胰管狭窄、糖尿病、慢性消化不良等远期并发症。结论内镜下胆胰管支架置入在胰头IPMN局部切除术是一种可有效保护胆胰管、减少术后胰瘘和远期胆胰管狭窄等并发症的方式。
Objective To investigate the clinical value of endoscopic biliary and pancreatic duct stents in enucleation of intraductal papillary mucinous neoplasm of pancreatic head.Methods The clinical data of 8 patients with pancreatic head IPMN with focal diameter less than 3.0 cm who underwent local resection after endoscopic ultrasonography(EUS)diagnosis combined with ERCP implantation of biliary and pancreatic duct stents were retrospectively analyzed in Hangzhou First People's Hospital from January 2020 to January 2023.Results 8 patients were diagnosed by CT and MRI:3 patients were located in the head of the pancreas,3 in the uncinate process,and 2 in the neck of the pancreas.Among them,4 patients had CA199 elevation(56.1~105.3kU/L).EUS showed that the tumor was 1.5~3.0 cm in length and 2.3 cm in average,with wall nodules(3.2~6.1 mm)in 3 cases.ERCP was successfully implanted into biliary and pancreatic duct stents,and hyperamylasemia occurred in 3 cases after ERCP.All the 8 cases underwent local resection.The frozen sections were non-invasive IPMN,and the incisal margins were negative.Postoperative grade A pancreatic fistula occurred in 1 case(12.5%),which recovered after conservative treatment without perioperative death.The mean length of stay was 10.2 days(7-14 days).Postoperative pathology showed that 7 cases were borderline tumors and 1 case was focal high-grade intraepithelial neoplasia.Biliary and pancreatic duct stents were removed 6 months after surgery,and all patients were followed up for more than half a year.No biliary and pancreatic duct stenosis,disease recurrence,diabetes,or chronic dyspepsia occurred.Conclusion Endoscopic biliary and pancreatic duct stents placement in the head of pancreas for IPMN resection is an effective way to protect biliary and pancreatic duct and reduce postoperative pancreatic fistula and long-term biliary and pancreatic duct stenosis.
作者
顾伟刚
王月
沈红璋
张筱凤
GU Wei-gang;WANG Yue;SHEN Hong-zhang(The people's Hospital of Hangzhou,Hangzhou 310000,China)
出处
《肝胆外科杂志》
2023年第4期296-299,共4页
Journal of Hepatobiliary Surgery
基金
多模态超声内镜联合外泌体多组学生物标志物的糖尿病胰腺癌早期精准诊断新技术的构建与临床研究,2023C03054
浙江省“尖兵”“领雁”研发攻关计划。
