The Curative Effect And Clinical Application Value Of Endoscopic Transpapillary Cyst Drainage On The Huge Pancreatic Pseudocysts And Pancreatic Abscess

Objective To evaluate the curative effect and clinical application value of endoscopic transpapillary cyst drainage(ETCD) on huge pancreatic pseudocysts(HPP) and pancreatic abscess.This study expects to confirm the selective applied standard of various endoscopic transpapillary drainage methods in different patient and the familiar problems in clinical treatment.Methods According to unification standard,10 cases had been selected and treated by ETCD from June 2003 to June 2006 in General Hospital of Shen Yang Military District of PLA,including 8 cases of uninfected HPP,1 case of infected HPP,1 case of pancreatic abscess.The detections of the pancreatic pseudocysts were from was 4.0cm×2.1cm to 12.1cm×7.0cm.The mean diameter of pancreatic pseudocysts was 7.1±2.7cm×5.3±2.2cm. The clinical treatment process and the change of relative investigation subjects were retrospectively studied.The routine ERCP preoperative preparation and the routine ERCP examinations were underwent in alll the 10 cases to find out the conditions of the papilla and the biliary tract, and received pancreatic contrast examinations for diagnosis of their factors.And such reference factors as the pancreatic opening,the existence of stone in the pancreatic duct,the pancreatic dilatation condition,the existence of stenosis in the pancreatic duct and its length, location and number,the existence of pseudocyst formation and its location,size,quantity, nature,etc.were found out from the performance of the pancreatic contrast examination. Treatments such as EST,EPS,pancreatic calculus extraction,pancreatic duct dilation by dilating bougies and balloon catheter,ENPD,ERPD,etc.were selectively applied according to those factors in combination with the natural and clinical conditions of the patients,so as to accomplish the drainage of huge pancreatic pseudocysts and pancreatic abscess.Results ERCP was used 25 times in 10 cases.EST and EPS were performed in 10 cases.ENPD were selectively used in 5 cases,ERPD in 6 cases,ENBD in 2 cases,ERBD in 3 cases.Pancreatic duct dilation by dilating bougies or balloon catheter was selectively used in 2 cases,and pancreatic duct stones extraction were used in 1 case and purulen embolisms extraction were applied in 2 cases.Postoperative infection of HPP occurred in 2 cases and acute pancreatitis was found in 1 case.The postoperative high GLU occurred in 4 cases,the acute obstructive suppurative cholangitis was found in 2 cases,the acute cholecystitis in 1 cases and hepatic abscess in 1 cases.Endoscopic transpapillary treatment failed in 1 case.Among 8 successful cases, pancreatic abscess and three patients of HPP had complete disappeared,2 cases of HPP had conspicuous diminution at least 50%and 2 cases had slight partial diminution lower 50%, and the increasing of HPP was formed in 1 caes.Postoperation,abdominal pain had complete resolution in 9 cases.Innocuousness papillary stricture was resolved in 3 cases. Sever acute pancreatitis were cured in 2 cases and Chronic pancreatitis had resolution in 7 cases.Mean follow-up was 16.5 months in 8 cases.Finally,four patients had complete resolution of HPP,3 cases,had partial resolution,and the remains cavity of HPP was formed in 1 caes.Slight epigastric discomfort and vague pain were found occasionally in 3 cases and could relieve by adjustment of drink and food.1 case was died in pancreatic cancer.Conclusion In the uninfected huge pancreatic pseudocyst patients who had operated in bilary or pancreas and who had recurrence pseudocysts after treatment by other methods, ETCD can resolve completely pancreatitis and promote diminution of HPP,and depress the recurrence rate.But,because of interference of patient treatment history,there was a higher difficulty and a lower success rate,and the curative effect was limited in those cases.In the uninfected huge pancreatic pseudocyst patients who had not been treated in the past,in the infected huge pancreatic pseudocyst patients and pancreatic abscess patients,ETCD had a significant clinical applied value and a certain curative effect.Infection of pancreatic pseudocyst was a most common complication after ETCD in the uninfected huge pancreatic pseudocyst patients.The obstruction of drainage path of HPP was major cause.The unhindered drainage path of HPP and rational application of antibiotics were the crux of precaution and treatment of pseudocyst infection complications.