治疗大面积感染性胰腺坏死的全新升级版双内镜方法:经皮内镜坏死切除术后进行经腔内镜引流/坏死切除术。

Santi Mangiafico, Helga Bertani, Flavia Pigò, Salvatore Russo, Marinella Lupo, Silvia Cocca, Giuseppe Grande, Ugo Germani, Raffaele Manta, Rita Conigliaro
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引用次数: 0

摘要

背景:10%到20%的急性胰腺炎病例可伴有胰腺、胰周组织或两者的坏死。我们报告了一个治疗感染性胰腺坏死(IPN)的新内镜方法的病例系列:从 2017 年 1 月到 2022 年 6 月,我们对患有 IPN 的连续患者进行了前瞻性研究,这些患者的胰腺组织从胃周区延伸至结肠旁肠沟或盆腔。治疗方案首先是放射学经皮引流,然后在导管轨道上放置全覆盖金属支架(FC-SEMS)。2至4天后,使用柔性内窥镜通过经皮通道进行经皮内窥镜坏死切除术(PEN)。大约 2 到 4 周后,当看到成熟的囊时,在 EUS 引导下使用腔内金属支架(LAMS)进行内镜下腔内引流(ETD)。结果:我们共收治了 18 名患者,其中男性占 50%,年龄为 60±12 岁。最常见的胰腺炎病因是胆源性(7 例),其次是酒精性(6 例);3 例胰腺炎由高脂血症引起,2 例为特发性。WON的平均大小为18±2厘米。PEN所用的SEMS为食管FC-SEMS。用于 ETD 的 LAMS 是 Hot Axios、Hot Spaxus 和 Nagistent。PEN和ETD的内镜介入平均时间分别为18±3天和37±4天。5例发生了不良事件:3例过度充气在腹部引入Verres针后缓解。2例术后消化道出血需要内窥镜干预。在所有病例中,脓毒症都得到了控制,出血也得到了缓解。没有观察到死亡病例:阶梯式经皮和经内镜坏死切除术是治疗合并中心和周围坏死的大体积 IPN 的有效策略。
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A New Step-Up Dual Endoscopic Approach for Large-Size Infected Pancreatic Necrosis: Percutaneous Endoscopic Necrosectomy Followed by Transluminal Endoscopic Drainage/Necrosectomy.

Background: Acute pancreatitis in 10% to 20% of cases can be associated with necrosis of the pancreatic gland, peripancreatic tissue, or both. We report a case series of a new endoscopic approach to treat infected pancreatic necrosis (IPN).

Patients and methods: Consecutive patients with IPN, extending from the perigastric area up to the paracolic gutters or into the pelvis, were prospectively studied from January 2017 to June 2022. The treatment protocol was radiologic percutaneous drainage as the first step, followed by fully covered metal stent placement (FC-SEMS) in the track of the catheter. Percutaneous endoscopic necrosectomy (PEN) was performed 2 to 4 days later using a flexible endoscope through the percutaneous tract. About 2 to 4 weeks later, when a matured sac was visible, EUS-guided endoscopic transluminal drainage (ETD) with lumen-apposing metal stents (LAMS) was performed. Control of sepsis with resolution of collection(s) was the primary outcome measure.

Results: We included 18 patients, males in 50% of cases with age 60±12 years old. Most frequent cause of pancreatitis was biliary (7 cases) followed by alcoholic in 6 cases; in 3 cases pancreatitis was caused by hyperlipemia and in 2 cases was idiopathic. Mean size of WON was 18±2 cm. For PEN, SEMSs used were esophageal FC-SEMS. LAMS used for ETD were Hot Axios, Hot Spaxus and Nagistent. Mean time of endoscopic intervention for PEN and ETD was 18±3 and 37±4 days, respectively. In 5 cases adverse events occurred: 3 cases of overinflations resolved with introduction of Verres needles in abdomen. In 2 cases postprocedural GI bleeding required endoscopic intervention. In all cases control of sepsis was reached together with resolution of collections. No cases of deaths were observed.

Conclusions: Step-up percutaneous and transluminal endoscopic necrosectomy therapy is an effective strategy for large-size IPN with combined central and peripheral necrosis.

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来源期刊
CiteScore
2.00
自引率
10.00%
发文量
103
审稿时长
3-8 weeks
期刊介绍: Surgical Laparoscopy Endoscopy & Percutaneous Techniques is a primary source for peer-reviewed, original articles on the newest techniques and applications in operative laparoscopy and endoscopy. Its Editorial Board includes many of the surgeons who pioneered the use of these revolutionary techniques. The journal provides complete, timely, accurate, practical coverage of laparoscopic and endoscopic techniques and procedures; current clinical and basic science research; preoperative and postoperative patient management; complications in laparoscopic and endoscopic surgery; and new developments in instrumentation and technology.
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