ERCP聯合硬鏡會師治療胰管離斷綜合征1例報道_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

彭邦劍 , 高友逵 , 文輝清 , 劉鴻亞 , 張志 , 劉天鵬 ,  宋曉薇

1. ;

Corresponding?author：

宋曉薇, Email: xiaowei_song92@163.com

Keywords：

胰管離斷綜合征; 感染性胰腺壞死; 硬質膽道鏡; 經內鏡逆行胰膽管造影術

DOI：

10.7507/1007-9424.202308040

Video：

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目的總結1例感染性胰腺壞死合并胰管離斷綜合征的微創治療效果。方法對該例患者，疾病早期采用多種方式進行穿刺引流治療，疾病后期采用經內鏡逆行胰膽管造影術（encoscopic retrograde cholangiopancreatography，ERCP）聯合硬質膽道鏡技術，在胰周積液的囊腔和主胰管之間建立通道，置入胰管塑料支架，引流積液。結果術后成功拔除外引流管，患者癥狀消失，檢驗指標恢復正常，影像學檢查顯示胰管支架連接十二指腸和胰體尾部，原有囊腫消失，胰管再次顯影，胰周無積液，術后恢復良好出院。結論感染性胰腺壞死合并胰管離斷綜合征的患者早期采用多種方式進行穿刺引流治療，后期采用ERCP聯合硬質膽道鏡技術、置入胰管塑料支架是一種可以進一步探索的微創治療方法。

Citation： 彭邦劍, 高友逵, 文輝清, 劉鴻亞, 張志, 劉天鵬, 宋曉薇. ERCP聯合硬鏡會師治療胰管離斷綜合征1例報道. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(1): 89-92. doi: 10.7507/1007-9424.202308040 Copy

1.	中華醫學會外科學分會胰腺外科學組. 中國急性胰腺炎診治指南 (2021). 浙江實用醫學, 2021, 26(6): 511-519, 535.
2.	Lepp?niemi A, Tolonen M, Tarasconi A, et al. 2019 WSES guidelines for the management of severe acute pancreatitis. World J Emerg Surg, 2019, 14: 27. doi: 10.1186/s13017-019-0247-0.
3.	Yuan X, Luo C, Wu J, et al. Abdominal paracentesis drainage attenuates intestinal mucosal barrier damage through macrophage polarization in severe acute pancreatitis. Exp Biol Med (Maywood), 2021, 246(18): 2029-2038.
4.	Liu L, Yan H, Liu W, et al. Abdominal paracentesis drainage does not increase infection in severe acute pancreatitis: a prospective study. J Clin Gastroenterol, 2015, 49(9): 757-763.
5.	Li W, Ou L, Fu Y, et al. Risk factors for concomitant infectious pancreatic necrosis in patients with severe acute pancreatitis: a systematic review and meta-analysis. Clin Res Hepatol Gastroenterol, 2022, 46(5): 101901. doi: 10.1016/j.clinre.2022.101901.
6.	宋宇, 張鵬, 楊利, 等. 基于CT和病程分期評估感染性胰腺壞死的臨床和預后特征. 中國CT和MRI雜志, 2023, 21(5): 133-135.
7.	Bomman S, Sanders D, Coy D, et al. Safety and clinical outcomes of early dual modality drainage (< 28 days) compared to later drainage of pancreatic necrotic fluid collections: a propensity score-matched study. Surg Endosc, 2023, 37(2): 902-911.
8.	Gao L, Zhang H, Li G, et al. The clinical outcome from early versus delayed minimally invasive intervention for infected pancreatic necrosis: a systematic review and meta-analysis. J Gastroenterol, 2022, 57(6): 397-406.
9.	Bang JY, Wilcox CM, Navaneethan U, et al. Impact of disconnected pancreatic duct syndrome on the endoscopic management of pancreatic fluid collections. Ann Surg, 2018, 267(3): 561-568.
10.	趙光, 崔云峰. 胰管離斷綜合征的診治進展. 肝膽外科雜志, 2021, 29(3): 163-167.
11.	Wang ZJ, Song YH, Li SY, et al. Endoscopic management of pancreatic fluid collections with disconnected pancreatic duct syndrome. Endosc Ultrasound, 2023, 12(1): 29-37.
12.	Chong E, Ratnayake CB, Saikia S, et al. Endoscopic transmural drainage is associated with improved outcomes in disconnected pancreatic duct syndrome: a systematic review and meta-analysis. BMC Gastroenterol, 2021, 21(1): 87. doi: 10.1186/s12876-021-01663-2.
13.	Larsen M, Kozarek RA. Management of disconnected pancreatic duct syndrome. Curr Treat Options Gastroenterol, 2016, 14(3): 348-359.
14.	Arvanitakis M, Dumonceau JM, Albert J, et al. Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines. Endoscopy, 2018, 50(5): 524-546.
15.	Maatman TK, Mahajan S, Roch AM, et al. Disconnected pancreatic duct syndrome predicts failure of percutaneous therapy in necrotizing pancreatitis. Pancreatology, 2020, 20(3): 362-368.
16.	Tarantino I, Carrozza L, Rizzo GEM, et al. Radiologic and endoscopic treatment for a disconnected pancreatic duct syndrome associated with percutaneous pancreatic fistula: achieving the “internalization of the fistula”. Endoscopy, 2023, 55(S01): E777-E778. doi: 10.1055/a-2088-8921.
17.	Wang L, Elhanafi S, Storm AC, et al. Impact of disconnected pancreatic duct syndrome on endoscopic ultrasound-guided drainage of pancreatic fluid collections. Endoscopy, 2021, 53(6): 603-610.

1. 中華醫學會外科學分會胰腺外科學組. 中國急性胰腺炎診治指南 (2021). 浙江實用醫學, 2021, 26(6): 511-519, 535.
2. Lepp?niemi A, Tolonen M, Tarasconi A, et al. 2019 WSES guidelines for the management of severe acute pancreatitis. World J Emerg Surg, 2019, 14: 27. doi: 10.1186/s13017-019-0247-0.
3. Yuan X, Luo C, Wu J, et al. Abdominal paracentesis drainage attenuates intestinal mucosal barrier damage through macrophage polarization in severe acute pancreatitis. Exp Biol Med (Maywood), 2021, 246(18): 2029-2038.
4. Liu L, Yan H, Liu W, et al. Abdominal paracentesis drainage does not increase infection in severe acute pancreatitis: a prospective study. J Clin Gastroenterol, 2015, 49(9): 757-763.
5. Li W, Ou L, Fu Y, et al. Risk factors for concomitant infectious pancreatic necrosis in patients with severe acute pancreatitis: a systematic review and meta-analysis. Clin Res Hepatol Gastroenterol, 2022, 46(5): 101901. doi: 10.1016/j.clinre.2022.101901.
6. 宋宇, 張鵬, 楊利, 等. 基于CT和病程分期評估感染性胰腺壞死的臨床和預后特征. 中國CT和MRI雜志, 2023, 21(5): 133-135.
7. Bomman S, Sanders D, Coy D, et al. Safety and clinical outcomes of early dual modality drainage (< 28 days) compared to later drainage of pancreatic necrotic fluid collections: a propensity score-matched study. Surg Endosc, 2023, 37(2): 902-911.
8. Gao L, Zhang H, Li G, et al. The clinical outcome from early versus delayed minimally invasive intervention for infected pancreatic necrosis: a systematic review and meta-analysis. J Gastroenterol, 2022, 57(6): 397-406.
9. Bang JY, Wilcox CM, Navaneethan U, et al. Impact of disconnected pancreatic duct syndrome on the endoscopic management of pancreatic fluid collections. Ann Surg, 2018, 267(3): 561-568.
10. 趙光, 崔云峰. 胰管離斷綜合征的診治進展. 肝膽外科雜志, 2021, 29(3): 163-167.
11. Wang ZJ, Song YH, Li SY, et al. Endoscopic management of pancreatic fluid collections with disconnected pancreatic duct syndrome. Endosc Ultrasound, 2023, 12(1): 29-37.
12. Chong E, Ratnayake CB, Saikia S, et al. Endoscopic transmural drainage is associated with improved outcomes in disconnected pancreatic duct syndrome: a systematic review and meta-analysis. BMC Gastroenterol, 2021, 21(1): 87. doi: 10.1186/s12876-021-01663-2.
13. Larsen M, Kozarek RA. Management of disconnected pancreatic duct syndrome. Curr Treat Options Gastroenterol, 2016, 14(3): 348-359.
14. Arvanitakis M, Dumonceau JM, Albert J, et al. Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines. Endoscopy, 2018, 50(5): 524-546.
15. Maatman TK, Mahajan S, Roch AM, et al. Disconnected pancreatic duct syndrome predicts failure of percutaneous therapy in necrotizing pancreatitis. Pancreatology, 2020, 20(3): 362-368.
16. Tarantino I, Carrozza L, Rizzo GEM, et al. Radiologic and endoscopic treatment for a disconnected pancreatic duct syndrome associated with percutaneous pancreatic fistula: achieving the “internalization of the fistula”. Endoscopy, 2023, 55(S01): E777-E778. doi: 10.1055/a-2088-8921.
17. Wang L, Elhanafi S, Storm AC, et al. Impact of disconnected pancreatic duct syndrome on endoscopic ultrasound-guided drainage of pancreatic fluid collections. Endoscopy, 2021, 53(6): 603-610.

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ERCP聯合硬鏡會師治療胰管離斷綜合征1例報道

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