目的分析探讨内镜超声(EUS)下胰腺假性囊肿经胃置管引流的疗效及并发症情况。方法回顾分析2001年以来经胃置管引流胰腺假性囊肿的24例患者病历及随访资料。引流方法采用 EUS 引导下穿刺囊肿,插入导丝,用探条或扩张水囊行针道扩张,置入...目的分析探讨内镜超声(EUS)下胰腺假性囊肿经胃置管引流的疗效及并发症情况。方法回顾分析2001年以来经胃置管引流胰腺假性囊肿的24例患者病历及随访资料。引流方法采用 EUS 引导下穿刺囊肿,插入导丝,用探条或扩张水囊行针道扩张,置入鼻囊肿引流管或1～4根双猪尾型塑料支架引流。术后定期随访,囊肿消失后拔除支架。结果 24例患者均完成囊肿穿刺、置管,手术成功率100%,死亡率为0。发生并发症8例(33.3%),其中严重并发症3例(12.5%),分别为出血、感染、支架移位各1例。平均随访21.2个月,2例失访,17例假性囊肿完全消失,2例囊肿明显缩小但持续存在2年以上,腹痛症状消失,1例感染性假性囊肿内镜引流无效转外科手术。内镜引流总的有效率为86.4%(19/22),无一例复发。结论 EUS 下经胃置管引流治疗胰腺假性囊肿是一种安全、有效的治疗方法,其常见并发症为出血和感染。展开更多
AIM: To perform a systematic review comparing the outcomes of endoscopic, percutaneous and surgical pancreatic pseudocyst drainage.METHODS: Comparative studies published between January 1980 and May 2014 were identifi...AIM: To perform a systematic review comparing the outcomes of endoscopic, percutaneous and surgical pancreatic pseudocyst drainage.METHODS: Comparative studies published between January 1980 and May 2014 were identified on Pub Med, Embase and the Cochrane controlled trials register and assessed for suitability of inclusion. The primary outcome was the treatment success rate. Secondary outcomes included were the recurrence rates, re-interventions, length of hospital stay, adverse events and mortalities.RESULTS: Ten comparative studies were identified and 3 were randomized controlled trials. Four studies reported on the outcomes of percutaneous and surgical drainage. Based on a large-scale national study, surgical drainage appeared to reduce mortality and adverse events rate as compared to the percutaneous approach. Three studies reported on the outcomes of endoscopic ultrasound(EUS) and surgical drainage. Clinical success and adverse events rates appeared to be comparable but the EUS approach reduced hospital stay, cost and improved quality of life. Three other studies comparedEUS and esophagogastroduodenoscopy-guided drainage. Both approaches were feasible for pseudocyst drainage but the success rate of the EUS approach was better for non-bulging cyst and the approach conferred additional safety benefits.CONCLUSION: In patients with unfavorable anatomy, surgical cystojejunostomy or percutaneous drainage could be considered. Large randomized studies with current definitions of pseudocysts and longer-term follow-up are needed to assess the efficacy of the various modalities.展开更多
Endoscopic ultrasonography (EUS) is well suited for assessment of the pancreas due to its high resolution and the proximity of the transducer to the pancreas, avoiding air in the gut. Evaluation of chronic pancreatiti...Endoscopic ultrasonography (EUS) is well suited for assessment of the pancreas due to its high resolution and the proximity of the transducer to the pancreas, avoiding air in the gut. Evaluation of chronic pancreatitis (CP) was an early target for EUS, initially just for diagnosis but later for therapeutic purposes. The diagnosis of CP is still accomplished using the standard scoring based on nine criteria, all considered to be of equal value. For diagnosis of any CP, at least three or four criteria must be fulf illed, but for diagnosis of severe CP at least six criteria are necessary. The Rosemont classif ication, more restrictive, aims to standardize the criteria and assigns different values to different features, but requires further validation. EUS-f ine needle aspiration (EUS-FNA) is less advisable for diagnosis of diffuse CP due to its potential side effects. Elastography and contrast-enhanced EUS are orientation in differentiating a focal pancreatic mass in a parenchyma with features of CP, but they cannot replace EUS-FNA. The usefulness of EUS-guided celiac block for painful CP is still being debated with regard to the best technique and the indications. EUS-guided drainage of pseudocysts is preferred in non-bulging pseudocysts or in the presence of portal hypertension. EUS-guided drainage of the main pancreatic duct should be reserved for cases in which endoscopic retrograde cholangiopancreatography has failed owing to difficult cannulation of the papilla or diff icult endotherapy. It should be performed only by highly skilled endoscopists, due to the high rate of complications.展开更多
Acute pancreatitis is characterized by acute chemical injury of the pancreatic parenchyma and peripancreatic tissue.The increased frequency of death in acute pancreatitis is directly correlated with the degree and pro...Acute pancreatitis is characterized by acute chemical injury of the pancreatic parenchyma and peripancreatic tissue.The increased frequency of death in acute pancreatitis is directly correlated with the degree and progress of pancreatic necrosis.Moreover,the occurrence of some local complications in acute pancreatitis,such as pancreatic hemorrhage,peripancreatic abscess or large pseudocyst,and pseudoaneurysm,could influence the choice of treatment for these patients.Magnetic resonance imaging(MRI) can be used to help evaluate the presence and degree of pancreatic necrosis,and is crucial for identifying complications of acute pancreatitis and predicting prognosis.The purpose of this article is to describe MRI techniques for acute pancreatitis,to review the spectrum of pancreatic and peripancreatic patterns,as well as to survey various complications secondary to acute pancreatitis on MRI.The role of MRI in the initial evaluation and staging of acute pancreatitis is emphasized.展开更多
文摘目的分析探讨内镜超声(EUS)下胰腺假性囊肿经胃置管引流的疗效及并发症情况。方法回顾分析2001年以来经胃置管引流胰腺假性囊肿的24例患者病历及随访资料。引流方法采用 EUS 引导下穿刺囊肿,插入导丝,用探条或扩张水囊行针道扩张,置入鼻囊肿引流管或1～4根双猪尾型塑料支架引流。术后定期随访,囊肿消失后拔除支架。结果 24例患者均完成囊肿穿刺、置管,手术成功率100%,死亡率为0。发生并发症8例(33.3%),其中严重并发症3例(12.5%),分别为出血、感染、支架移位各1例。平均随访21.2个月,2例失访,17例假性囊肿完全消失,2例囊肿明显缩小但持续存在2年以上,腹痛症状消失,1例感染性假性囊肿内镜引流无效转外科手术。内镜引流总的有效率为86.4%(19/22),无一例复发。结论 EUS 下经胃置管引流治疗胰腺假性囊肿是一种安全、有效的治疗方法,其常见并发症为出血和感染。
文摘AIM: To perform a systematic review comparing the outcomes of endoscopic, percutaneous and surgical pancreatic pseudocyst drainage.METHODS: Comparative studies published between January 1980 and May 2014 were identified on Pub Med, Embase and the Cochrane controlled trials register and assessed for suitability of inclusion. The primary outcome was the treatment success rate. Secondary outcomes included were the recurrence rates, re-interventions, length of hospital stay, adverse events and mortalities.RESULTS: Ten comparative studies were identified and 3 were randomized controlled trials. Four studies reported on the outcomes of percutaneous and surgical drainage. Based on a large-scale national study, surgical drainage appeared to reduce mortality and adverse events rate as compared to the percutaneous approach. Three studies reported on the outcomes of endoscopic ultrasound(EUS) and surgical drainage. Clinical success and adverse events rates appeared to be comparable but the EUS approach reduced hospital stay, cost and improved quality of life. Three other studies comparedEUS and esophagogastroduodenoscopy-guided drainage. Both approaches were feasible for pseudocyst drainage but the success rate of the EUS approach was better for non-bulging cyst and the approach conferred additional safety benefits.CONCLUSION: In patients with unfavorable anatomy, surgical cystojejunostomy or percutaneous drainage could be considered. Large randomized studies with current definitions of pseudocysts and longer-term follow-up are needed to assess the efficacy of the various modalities.
基金Supported by A National Grant from the Education Ministry PANGEN PNII 42110/2008
文摘Endoscopic ultrasonography (EUS) is well suited for assessment of the pancreas due to its high resolution and the proximity of the transducer to the pancreas, avoiding air in the gut. Evaluation of chronic pancreatitis (CP) was an early target for EUS, initially just for diagnosis but later for therapeutic purposes. The diagnosis of CP is still accomplished using the standard scoring based on nine criteria, all considered to be of equal value. For diagnosis of any CP, at least three or four criteria must be fulf illed, but for diagnosis of severe CP at least six criteria are necessary. The Rosemont classif ication, more restrictive, aims to standardize the criteria and assigns different values to different features, but requires further validation. EUS-f ine needle aspiration (EUS-FNA) is less advisable for diagnosis of diffuse CP due to its potential side effects. Elastography and contrast-enhanced EUS are orientation in differentiating a focal pancreatic mass in a parenchyma with features of CP, but they cannot replace EUS-FNA. The usefulness of EUS-guided celiac block for painful CP is still being debated with regard to the best technique and the indications. EUS-guided drainage of pseudocysts is preferred in non-bulging pseudocysts or in the presence of portal hypertension. EUS-guided drainage of the main pancreatic duct should be reserved for cases in which endoscopic retrograde cholangiopancreatography has failed owing to difficult cannulation of the papilla or diff icult endotherapy. It should be performed only by highly skilled endoscopists, due to the high rate of complications.
基金Supported by Grant No. 206126,Key project of Science and Technology Research,and NCET-06-0820,Ministry of Education,China
文摘Acute pancreatitis is characterized by acute chemical injury of the pancreatic parenchyma and peripancreatic tissue.The increased frequency of death in acute pancreatitis is directly correlated with the degree and progress of pancreatic necrosis.Moreover,the occurrence of some local complications in acute pancreatitis,such as pancreatic hemorrhage,peripancreatic abscess or large pseudocyst,and pseudoaneurysm,could influence the choice of treatment for these patients.Magnetic resonance imaging(MRI) can be used to help evaluate the presence and degree of pancreatic necrosis,and is crucial for identifying complications of acute pancreatitis and predicting prognosis.The purpose of this article is to describe MRI techniques for acute pancreatitis,to review the spectrum of pancreatic and peripancreatic patterns,as well as to survey various complications secondary to acute pancreatitis on MRI.The role of MRI in the initial evaluation and staging of acute pancreatitis is emphasized.
