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中华胃肠内镜电子杂志 ›› 2020, Vol. 07 ›› Issue (03) : 97 -107. doi: 10.3877/cma.j.issn.2095-7157.2020.03.001

所属专题: 文献 指南共识

共识与指南

中国胰瘘消化内镜诊治专家共识(2020,北京)
中华医学会消化内镜学分会1, 中国医师协会内镜医师分会2, 北京医学会消化内镜学分会3   
  1. 1. 100710 北京,中华医学会消化内镜学分会
    2. 100055 北京,中国医师协会内镜医师分会
    3. 100031 北京,北京医学会消化内镜学分会
    4. 100853 北京,解放军总医院第一医学中心消化内科
    5. 200433 上海,海军军医大学长海医院消化内科
  • 收稿日期:2020-09-15 出版日期:2020-08-15
  • 基金资助:
    军队"十一五"基金(08G137)

Consensus of Chinese experts on the endoscopic diagnosis and treatment of pancreatic leak(2020, Beijing)

Chinese Society of Digestive Endoscopy1, Chinese Digestive Endoscopy Association2, Beijing Digestive Endoscopy Society3   

  • Received:2020-09-15 Published:2020-08-15
引用本文:

中华医学会消化内镜学分会, 中国医师协会内镜医师分会, 北京医学会消化内镜学分会. 中国胰瘘消化内镜诊治专家共识(2020,北京)[J]. 中华胃肠内镜电子杂志, 2020, 07(03): 97-107.

Chinese Society of Digestive Endoscopy, Chinese Digestive Endoscopy Association, Beijing Digestive Endoscopy Society. Consensus of Chinese experts on the endoscopic diagnosis and treatment of pancreatic leak(2020, Beijing)[J]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2020, 07(03): 97-107.

表1 证据级别分类
表2 中国胰瘘内镜下诊治专家共识陈述汇总
定义与病因
? 1.胰瘘是指各种原因引起的富含胰酶的液体在胰管上皮和其他上皮组织之间的异常交通所引起的一系列临床综合征。
? 2.胰瘘常见的病因主要为胰腺外伤、胰腺及胰周外科手术、急性坏死性胰腺炎等。
诊断
? 3.经内镜逆行胰胆管造影(endoscopic retrograde cholangio-pancreatography, ERCP)及窦道造影是胰瘘诊断金标准。
? 4.外科术后胰瘘的诊断标准为:术后≥3 d后腹腔引流管仍有液体流出,且其淀粉酶浓度高于血清淀粉酶正常值上限的3倍。
? 5.急慢性胰腺炎相关胰瘘诊断标准为:(1)存在急性坏死性胰腺炎发作病史;(2)影像学支持胰瘘诊断。
分型分级
? 6.胰瘘分型建议根据胰瘘部位、开口方式及既往胰腺切除术式分型。外科术后分级建议采用ISGPS制定的2016版更新术后胰瘘(postoperative pancreatic fistula,POPF)分级。
适应证
? 7.内镜下胰瘘治疗主要用于有明显症状且保守治疗无效的患者。
预防性治疗
? 8.不推荐常规内镜下处理来预防外科术后胰瘘的发生。
内镜下手术治疗
? 9.对于与近端胰管相通的胰瘘,内镜下鼻胰管引流术、内镜下胰管支架置入术是内镜下常规治疗方式。
? 10.内镜下常规治疗失败的胰瘘,可尝试行内镜下封堵剂封堵治疗。
? 11. EUS引导下支架引流术可作为胰瘘所致胰周液体积聚的一线治疗方式,必要时可行内镜直视下坏死组织清创术。
? 12. EUS引导下引流术的支架选择(塑料/金属)目前尚存争议,但对于合并坏死的胰周液体积聚,更倾向于新型两端膨大式金属支架。
表3 胰瘘内镜分型
表4 POPF分级(2016年修订版)
附录1 中英文缩略词表
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