摘要
胰管断裂综合征(DPDS)是急性坏死性胰腺炎(ANP)的重要并发症之一,由于胰管断裂导致胰液无法正常流入胃肠道,常导致反复包裹性胰腺坏死、胰腺囊肿及慢性胰腺炎等。其主要诱发因素为ANP中的主胰管坏死,常好发于胰腺颈部。其常用的诊断方法包括无创检查和侵入性检查。无创检查主要有CT或增强CT(CECT)、磁共振胰胆管造影(MRCP)或胰泌素增强磁共振胰胆管造影(S-MRCP)等,可评估胰管完整性和断裂部位。侵入性检查主要有内镜逆行胰胆管造影(ERCP)、超声内镜(EUS)和手术探查,其中ERCP是目前的金标准,胰管断裂处可显示造影剂外渗。MRCP或S-MRCP被推荐为首选诊断方法。DPDS的治疗目的是积聚胰液的充分引流,治疗方式包括保守治疗、经皮穿刺引流、内镜或外科干预等。保守治疗和经皮穿刺引流效果有限,不能重建断裂的胰管。内镜治疗主要包括跨壁引流和经乳头生理性引流,引流方式主要使用各类支架,如双蘑菇头金属支架(LAMS)、塑料支架等。外科干预主要是远端胰腺切除术与内引流术,适用于内镜下治疗困难或多次复发的病人。
Disconnected Pancreatic Duct Syndrome,(DPDS)is a significant complication of acute necrotizing pancreatitis(ANP).It results from the rupture of the pancreatic duct,causing abnormal pancreatic fluid drainage into the gastrointestinal tract.DPDS often leads to recurrent enveloping pancreatic neprimary trigger is the main pancreatic duct necrosis,predominantly occurring in the pancreatic neck.Diagnostic methods commonly employed include non-invasive and invasive procedures.Non-invasive methods encompass computed tomography(CT)or contrast-enhanced CT(CECT),magnetic resonance cholangiopancreatography(MRCP),and secretin-enhanced magnetic resonance cholangiopancreatography(S-MRCP),assessing pancreatic duct integrity and rupture site.Invasive procedures include endoscopic retrograde cholangiopancreatography(ERCP),endoscopic ultrasound(EUS),and surgical exploration,with ERCP currently being the gold standard,revealing the extravasation of contrast agents.MRCP or S-MRCP is recommended as the preferred diagnostic approach.The objective of DPDS treatment is adequate drainage of accumulated pancreatic fluid.Treatment modalities comprise conservative management,percutaneous drainage,and endoscopic,or surgical interventions.Conservative and percutaneous drainage have limited efficacy and do not reconstruct the ruptured pancreatic duct.Endoscopic interventions involve transmural drainage and physiological drainage via the papilla,utilizing various stents such as LAMS,plastic stents,etc.Surgical interventions encompass distal pancreatic resection and internal drainage,suitable for patients experiencing difficulties with endoscopic treatment or recurrent episodes.
作者
苏铁
武林枫
王刚
SU Tie;WU Lin-feng;WANG Gang(Department of Pancreatic and Biliary Surgery,the First Affiliated Hospital of Harbin Medical University,Key Laboratory of Hepatosplenic Surgery(Ministry of Education),Harbin 150001,China)
出处
《中国实用外科杂志》
CAS
CSCD
北大核心
2023年第12期1436-1440,共5页
Chinese Journal of Practical Surgery
基金
国家自然科学基金项目(No.82070657,No.82370651)。
关键词
急性坏死性胰腺炎
胰管断裂综合征
主胰管断裂
包裹性坏死
慢性胰腺炎
acute necrotizing pancreatitis
disconnected pan-creatic duct syndrome
main pancreatic duct
walled-off necro-sis
chronic pancreatitis
