全覆膜金属支架在无法行外科手术的胰腺导管内乳头状黏液性肿瘤患者中的应用

Application of fully covered metal stent in patients with intraductal papillary mucinous neoplasm of the pancreas that cannot be operated

摘要:

目的 探讨全覆膜金属支架在治疗无法行外科手术的胰腺导管内乳头状黏液性肿瘤（IPMN）患者中的应用价值。方法 回顾性分析2015年12月－2020年6月在江苏省苏北人民医院内镜诊治中心行内镜逆行胰胆管造影术（ERCP），在胰管留置全覆膜金属支架的9例IPMN患者的临床资料。结果 9例患者均行ERCP，术中见乳头呈鱼嘴样开口，插管后均可见胶冻状液体流出，造影见主胰管局部或弥漫扩张，分枝胰管呈囊状扩张，5例置入10 mm×80 mm、4例置入10 mm×60 mm全覆膜金属支架，2例术中同时置入胆道支架。术后患者腹痛和恶心呕吐等症状明显缓解，2例术后出现高淀粉酶血症，给予对症治疗后缓解，无胰腺炎、胆管炎、出血和穿孔等并发症发生。术后随访12～24个月，无腹痛和复发，无支架移位，合并糖尿病患者血糖控制稳定，无新发糖尿病，1例随访至16个月时，支架堵塞，行胰管清理及支架更换。出院当天生活质量卡氏评分为（96.67±3.54）分，较术前的（82.78±3.63）分明显提高，两者比较，差异有统计学意义（P < 0.05），术后3和6个月生活质量卡氏评分为（94.82±3.87）和（91.33±2.50）分，与出院当天比较，差异无统计学意义（P > 0.05）。结论 对于无法行外科手术的IPMN患者，内镜下胰管全覆膜金属支架置入术安全有效，能有效延缓疾病进展，减少胰腺炎复发和手术频次，提高患者生活质量，值得临床进一步推广。

Abstract:

Objective To investigate the application value of fully covered metal stent in treatment of intraductal papillary mucinous neoplasm of the pancreas (IPMN) patients who cannot be operated.Methods A retrospective analysis was performed on the clinical data of 9 patients with IPMN who underwent endoscopic retrograde cholangiopancreatography (ERCP) and placed a metal stent in the pancreatic duct from December 2015 to June 2020.Results All the 9 patients in this study underwent ERCP. During the operation, the nipple opening was fish-mouthed, and the jelly-like liquid flowed out after intubation. The main pancreatic ducts were locally or diffusely dilated during the radiography. The branched pancreatic duct showed cystic expansion. 5 cases were implanted with 10 mm × 80 mm, 4 cases were implanted with 10 mm × 60 mm fully covered metal stents, and 2 cases were simultaneously implanted with biliary stents during the operation. The symptoms of abdominal pain, nausea and vomiting were alleviated significantly after the operation, and hyperamylasemia occurred in 2 cases after the operation, which was relieved after treatment; There were no complications such as pancreatitis, cholangitis, hemorrhage, and perforation. Follow-up for 12~24 months after operation, no recurrence of abdominal pain, no recurrence of pancreatitis, no stent displacement, stable blood glucose control in patients with diabetes, no new diabetes. One case had stent blockage at the 16th month of follow-up, and underwent pancreatic duct cleaning and stent replacement. The Karnofsky score of preoperative quality of life was (82.78 ± 3.63), which increased to (96.67 ± 3.54) on the day of discharge after surgery, with statistical significance before and after surgery (P < 0.05). The scores of 3 and 6 months after surgery were (94.82 ± 3.87) and (91.33 ± 2.50), which were not statistically significant (P > 0.05) compared to the day of discharge after surgery.Conclusion For patients with IPMN who cannot be operated, the endoscopic pancreatic duct fully covered metal stent implantation is safe and effective, can effectively delay the disease progression, reduce the recurrence of pancreatitis, and reduce the frequency of surgery, improve patients’ quality of life. It is worthy of further clinical promotion.