【摘要】 目的 探讨超声内镜(endoscopic ultrasonography,EUS)引导下经胃壁穿刺放置塑料支架引流管治疗胰腺假性囊肿(pancreatic pseudocysts PPC)的疗效及并发症。方法 回顾性分析我院2012年4月~2014年1月诊治的重症胰腺炎合并胰腺假性囊肿9例。应用彩色多普勒线阵型超声内镜扫查定位,明确病变部位,选择合适穿刺点,置入导丝后用一次性针状刀切开囊壁,用扩张探条扩张后置入双猪尾巴塑料支架(视病情植入1~2根)。塑料支架术后1个月、3个月定期随访,3个月后假性囊肿消失,拔除塑料支架。定期行腹部B超或CT检查,随访1年。结果 本组9例患者,穿刺引流成功9例,成功率为100%,术后第2天发热2例,考虑囊肿并发感染,1例静脉滴注抗生素后缓解,另一例改为亚胺培南后,体温控制。1例患者回当地医院,1个月后自行拔出塑料支架,3个月后复发。结论 超声内镜引导下经胃壁穿刺置管引流术治疗胰腺假性囊肿安全、有效,且创伤小,并发症少,恢复快。如条件许可应尽量多植入双猪尾塑料支架,其疗效更佳,值得临床应用。更多还原

【Abstract】 Objective To explore the effect and complication of endoscopic ultrasonography- guided(EUS-guided)plastic stent implantation for puncture drainage of pancreatic pseudocysts.Methods Clinical data of 9 patients with severe pancreatitis and pancreatic pseudocysts from Apr.2012 to Jan.2014 were analyzed retrospectively.Lesion sites were determined and appropriate puncture point was chosen by color Doppler line shape endoscopic ultrasonography scan.Guidewire was placed into the pseudocyst.A tiny incision was made on the capsule wall of the pseudocyst by disposable needle knife.Then double pigtail stents internal drainage(1 or 2 depending on the state of illness)were put after dilated into the pseudocyst.Patients were followed up after the first and third month.The stent was pulled out after pancreatic pseudocysts disappeared.All patients were examined by CT and B- ultrasonic as well as 1year follow- up.Results The success rate of drainage procedure was 100%.2 of 9 patients had a fever two days after surgery;postoperative infection of the pseudocysts was the cause probably.1 patient cured by intravenous infusion of antibiotics sensitive,and fever of the other patient was controlled by intravenous infusion of imipenem.Plastic stent implantation 1 patient was pulled out in local hospital after one month and pseudocyst relapsed three months later.Conclusion EUS- guided puncture drainage can be used to treat pancreatic pseudocysts with acceptable feasibility,efficacy and safety.More plastic stents can be placed if possible,which is worthy of promoting in clinical.更多还原