免X线超声内镜下透壁引流治疗胰腺假性囊肿的单中心回顾性分析

Retrospective analysis of X-ray free transmural drainage of pancreatic pseudocysts using echoendoscope

摘要:

目的 探讨免X线超声内镜下胰腺假性囊肿（PPC）透壁引流，对比传统X线引导下透壁引流的临床效果和安全性。方法 回顾性分析2018年1月－2021年6月就诊于该院的33例行超声内镜下PPC透壁引流术患者的临床资料。其中，免X线组14例和X线引导组19例，比较两组患者手术成功率、手术时间和并发症发生率等。结果 33例PPC患者均成功完成手术（100.00%），免X线组手术时间为（28.30±13.00）min，明显短于X线引导组的（46.79±18.00）min，差异有统计学意义（P < 0.05）。免X线组2例（14.29%）出现术后并发症。其中，1例患者由于合并部分包裹性坏死，治疗后出现了感染和发热，抗感染治疗效果不理想，再次进行超声内镜下鼻胆管引流后，症状改善；另1例由于合并区域性门静脉高压症，术后出现上消化道出血，行介入治疗后，痊愈出院。X线引导组术后并发症4例（21.05%）。其中，2例因出现囊腔内感染而再次引流；2例出现上消化道出血，1例保守治疗成功，1例行开腹手术止血治疗和囊肿外引流术。结论 单纯性PPC行免X线超声内镜下透壁引流术，安全、有效，手术时间短，且内镜医生能够避免X线辐射损伤，值得临床推广。

Abstract:

Objective To investigate the clinical effect and safety of transmural drainage of pancreatic pseudocysts (PPC) under X-ray free echoendoscope compared with X-ray guided transmural drainage of PPC.Methods Clinical data of 33 patients diagnosed with PPC from January 2018 to June 2021 were collected and analyzed retrospectively. 14 patients underwent X-ray free transmural drainage using echoendoscope while 19 patients got treatment with X-ray. The surgical success rate, operation time and complications were analyzed.Results All the 33 patients (100.00%) with PPC were successfully operated. The average operation time of X-ray free group was (28.30 ± 13.00) min which is obviously shorter than that of X-ray group (46.79 ± 18.00) min (P < 0.05). Only two cases had complications (14.28%) in X-ray free group, one patient had infection and fever after treatment, which improved after endoscopic nasobiliary drainage (ENBD). Another case with regional portal hypertension got postoperative bleeding, which was relieved after interventional treatment. Four cases in X-ray group had complications (21.05%), two of them received re-drainage due to infection, two of them showed upper gastrointestinal bleeding, 2 cases experienced upper gastrointestinal bleeding, 1 case was successfully treated conservatively, and 1 case underwent open surgery for hemostasis and external cyst drainage.Conclusion The X-ray free transmural drainage of PPC using echoendoscope is safe and effective, takes shorter time of operation, and the operator is able to avoid the damage of X-ray, which is worthy of clinical promotion .