Результаты внутреннего дренирования псевдокист поджелудочной железы под контролем эндо-УЗИ

Цель. Провести сравнительный анализ ближайших и отдаленных результатов внутреннего дренирования псевдокист поджелудочной железы под контролем эндо-УЗИ и открытых дренирующих операций.

Материал и методы. С 2011 по 2016 г. 32 больным выполнено внутреннее дренирование псевдокист поджелудочной железы под контролем эндо-УЗИ. Другим 32 пациентам выполнены открытые дренирующие операции.

Результаты. В группе эндоскопического дренирования уровень технического успеха составил 97%, уровень клинического успеха – 85%, уровень осложнений – 26%. В отдаленном периоде рецидива псевдокист не отмечено. Сравнительный анализ с группой открытых операций показал преимущество эндоскопического метода в продолжительности операции (p< 0,01), величине кровопотери (p< 0,01) и продолжительности пребывания больных в стационаре (p< 0,01).

Заключение. Внутреннее дренирование под контролем эндо-УЗИ как метод устранения псевдокист поджелудочной железы в рамках комплексного лечения хронического панкреатита характеризуется высоким уровнем технического и клинического успеха при низкой частоте осложнений и отсутствии рецидива в отдаленном периоде.

1. Baron T.H., Thaggard W.G., Morgan D.E., Stanley R.J. Endoscopic therapy for organized pancreatic necrosis. Gastroenterology. 1996; 111 (3): 755-764.

2. Kloppel G. Pseudocysts and other non-neoplastic cysts of the pancreas. Semin. Diagn. Pathol. 2000; 17 (1): 7-15.

3. Arvanitakis M., Delhaye M., Chamlou R., Matos C., Closset J., Medhi A., Baize M., Le Moine O., Deviere J. Endoscopic therapy for main pancreatic-duct rupture after Silastic-ring vertical gastroplasty. Gastrointest. Endosc. 2005; 62 (1): 143-151.

4. Baron T.H., Harewood G.C., Morgan D.E., Yates M.R. Outcome differences after endoscopic drainage of pancreatic necrosis, acute pancreatic pseudocysts, and chronic pancreatic pseudocysts. Gastrointest. Endosc. 2002; 56 (1): 7-17.

5. Gouyon B., Levy P., Ruszniewski P., Zins M., Hammel P., Vilgrain V., Sauvanet A., Belghiti J., Bernades P. Predictive factors in the outcome of pseudocysts complicating alcoholic chronic pancreatitis. Gut. 1997; 41 (6): 821-825.

6. Yeo C.J., Bastidas J.A., Lynch-Nyhan A., Fishman E.K., Zinner M.J., Cameron J.L. The natural history of pancreatic pseudocysts documented by computed tomography. Surg. Gynecol. Obstet. 1990; 170 (5): 411-417.

7. Warshaw A.L., Rattner D.W. Timing of surgical drainage for pancreatic pseudocyst. Clinical and chemical criteria. Ann. Surg. 1985; 202 (6): 720-724.

8. Bradley E.L., 3rd. A clinically based classification system for acute pancreatitis. Ann. Chir. 1993; 47 (6): 537-541.

9. Boerma D., van Gulik T.M., Obertop H., Gouma D.J. Internal drainage of infected pancreatic pseudocysts: safe or sorry? Dig. Surg. 1999; 16 (6): 501-505.

10. Ahearne P.M., Baillie J.M., Cotton P.B., Baker M.E., Meyers W.C., Pappas T.N. An endoscopic retrograde cholangiopancreatography (ERCP)-based algorithm for the management of pancreatic pseudocysts. Am. J. Surg. 1992; 163 (1): 111-115; discussion 115-116.

11. Adams D.B., Harvey T.S., Anderson M.C. Percutaneous catheter drainage of infected pancreatic and peripancreatic fluid collections. Arch. Surg. 1990; 125 (12): 1554-1557.

12. Singhal S., Rotman S.R., Gaidhane M., Kahaleh M. Pancreatic fluid collection drainage by endoscopic ultrasound: an update. Clin. Endosc. 2013; 46 (5): 506-514. https://doi.org/10.5946/ce.2013.46.5.506.

13. Antillon M.R., Shah R.J., Stiegmann G., Chen Y.K. Single-step EUS-guided transmural drainage of simple and complicated pancreatic pseudocysts. Gastrointest. Endosc. 2006; 63 (6): 797-803. https://doi.org/10.1016/j.gie.2005.10.025.

14. Sanchez Cortes E., Maalak A., Le Moine O., Baize M., Delhaye M., Matos C., Deviere J. Endoscopic cystenterostomy of nonbulging pancreatic fluid collections. Gastrointest. Endosc. 2002; 56 (3): 380-386.

15. Baron T.H. Drainage of pancreatic fluid collections: is EUS really necessary? Gastrointest. Endosc. 2007; 66 (6): 1123-1125. https://doi.org/10.1016/j.gie.2007.05.014.

16. Giovannini M. What is the best endoscopic treatment for pancreatic pseudocysts? Gastrointest. Endosc. 2007; 65 (4): 620-623. https://doi.org/10.1016/j.gie.2006.12.046.

17. Замолодчиков Р.Д., Солодинина Е.Н., Старков Ю.Г. Внутреннее дренирование псевдокист поджелудочной железы. Хирургия. Журнал им. Н.И. Пирогова. 2015; 4: 68-75.

18. Varadarajulu S., Christein J.D., Wilcox C.M. Frequency of complications during EUS-guided drainage of pancreatic fluid collections in 148 consecutive patients. J. Gastroenterol. Hepatol. 2011; 26 (10): 1504-1508. https://doi.org/10.1111/j.1440-1746.2011.06771.x.

19. Ahn J.Y., Seo D.W., Eum J., Song T.J., Moon S.H., Park do H., Lee S.S., Lee S.K., Kim M.H. Single-step EUS-guided transmural drainage of pancreatic pseudocysts: Analysis of technical feasibility, efficacy, and safety. Gut Liver. 2010; 4 (4): 524-529. https://doi.org/10.5009/gnl.2010.4.4.524.

20. Puri R., Mishra S.R., Thandassery R.B., Sud R., Eloubeidi M.A. Outcome and complications of endoscopic ultrasound guided pancreatic pseudocyst drainage using combined endoprosthesis and naso-cystic drain. J. Gastroenterol. Hepatol. 2012; 27 (4): 722-727. https://doi.org/10.1111/j.1440-1746.2012.07089.x.

21. Kunzli H.T., Timmer R., Schwartz M.P., Witteman B.J., Weusten B.L., van Oijen M.G., Siersema P.D., Vleggaar F.P. Endoscopic ultrasonography-guided drainage is an effective and relatively safe treatment for peripancreatic fluid collections in a cohort of 108 symptomatic patients. Eur. J. Gastroenterol. Hepatol. 2013; 25 (8): 958-963. https://doi.org/10.1097/MEG.0b013e3283612f03.

22. Kato S., Katanuma A., Maguchi H., Takahashi K., Osanai M., Yane K., Kim T., Kaneko M., Takaki R., Matsumoto K., Matsumori T., Gon K., Tomonari A. Efficacy, safety, and longterm follow-up results of EUS-guided transmural drainage for pancreatic pseudocyst. Diagn. Ther. Endosc. 2013; 2013: 924291. https://doi.org/10.1155/2013/924291.

23. Shamah S., Okolo P.I., 3rd. Systematic review of endoscopic cyst gastrostomy. Gastrointest. Endosc. Clin. N. Am. 2018; 28 (4): 477-492. https://doi.org/10.1016/j.giec.2018.06.002.

24. Vosoghi M., Sial S., Garrett B., Feng J., Lee T., Stabile B.E., Eysselein V.E. EUS-guided pancreatic pseudocyst drainage: review and experience at Harbor-UCLA Medical Center. Med. Gen. Med. 2002; 4 (3): 2.

25. Pitchumoni C.S., Agarwal N. Pancreatic pseudocysts. When and how should drainage be performed? Gastroenterol. Clin. N. Am. 1999; 28 (3): 615-639.

26. Bradley E.L., Clements J.L., Jr., Gonzalez A.C. The natural history of pancreatic pseudocysts: a unified concept of management. Am. J. Surg. 1979; 137 (1): 135-141.

27. Bradley E.L., Gonzalez A.C., Clements J.L., Jr. Acute pancreatic pseudocysts: incidence and implications. Ann. Surg. 1976; 184 (6): 734-737.

28. Itoi T., Binmoeller K.F., Shah J., Sofuni A., Itokawa F., Kurihara T., Tsuchiya T., Ishii K., Tsuji S., Ikeuchi N., Moriyasu F. Clinical evaluation of a novel lumen-apposing metal stent for endosonography-guided pancreatic pseudocyst and gallbladder drainage (with videos). Gastrointest. Endosc. 2012; 75 (4): 870-876. https://doi.org/10.1016/j.gie.2011.10.020.

29. Gornals J.B., De la Serna-Higuera C., Sanchez-Yague A., Loras C., Sanchez-Cantos A.M., Perez-Miranda M. Endosonography-guided drainage of pancreatic fluid collections with a novel lumen-apposing stent. Surg. Endosc. 2013; 27 (4): 1428-1434. https://doi.org/10.1007/s00464-012-2591-y.

30. Petrone M.C., Archibugi L., Forti E., Conigliaro R., Di Mitri R., Tarantino I., Fabbri C., Larghi A., Testoni S.G.G., Mutignani M., Arcidiacono P.G. Novel lumen-apposing metal stent for the drainage of pancreatic fluid collections: An Italian multicentre experience. Un. Eur. Gastroenterol. J. 2018; 6 (9): 1363-1371. https://doi.org/10.1177/2050640618785078.

31. Yang J., Chen Y.I., Friedland S., Holmes I., Paiji C., Law R., Hosmer A., Stevens T., Matheus F., Pawa R., Mathur N., Sejpal D., Inamdar S., Berzin T.M., DiMaio C.J., Gupta S., Yachimski P.S., Anderloni A., Repici A., James T., Jamil L.H., Ona M., Lo S.K., Gaddam S., Dollhopf M., Alammar N., Shieh E., Bukhari M., Kumbhari V., Singh V., Brewer O., Sanaei O., Fayad L., Ngamruengphong S., Shin E.J., Baron T.H., Khashab M.A. Lumen-apposing stents versus plastic stents in the management of pancreatic pseudocysts: a large, comparative, international, multicenter study. Endoscopy. 2018. https://doi.org/10.1055/a-0759-1353.

32. Varadarajulu S., Bang J.Y., Phadnis M.A., Christein J.D., Wilcox C.M. Endoscopic transmural drainage of peripancreatic fluid collections: outcomes and predictors of treatment success in 211 consecutive patients. J. Gastrointest. Surg. 2011; 15 (11): 2080-2088. https://doi.org/10.1007/s11605-011-1621-8.

33. Yao Y., Zhang D., Guo J., Qi K., Li F., Zhu J., Wang D., Chen J., Xu C., Wang L., Wang K., Jin Z., Li Z. A novel selfexpanding biflanged metal stent vs tubular metal stent for EUSguided transmural drainage of pancreatic pseudocyst: A retrospective, cohort study. Medicine (Baltimore). 2019; 98 (3): e14179. https://doi.org/10.1097/MD.0000000000014179.

34. Arvanitakis M., Delhaye M., Bali M.A., Matos C., De Maertelaer V., Le Moine O., Deviere J. Pancreatic-fluid collections: a randomized controlled trial regarding stent removal after endoscopic transmural drainage. Gastrointest. Endosc. 2007; 65 (4): 609-619. https://doi.org/10.1016/j.gie.2006.06.083.