超声内镜引导胰管引流术的适应证分层与临床策略述评

doi:10.3969/j.issn.1674-8115.2026.07.003

上海交通大学学报（医学版） ›› 2026, Vol. 46 ›› Issue (7): 847-856.doi: 10.3969/j.issn.1674-8115.2026.07.003

• 前沿述评 • 上一篇

超声内镜引导胰管引流术的适应证分层与临床策略述评

常雨欣, 李百文(), 倪建波()

上海交通大学医学院附属第一人民医院消化内科，上海 201620

收稿日期:2026-03-09 接受日期:2026-04-09 出版日期:2026-07-07 发布日期:2026-07-07
通讯作者: 倪建波，副主任医师，博士；电子信箱：jianbo.ni@shgh.cn。
李百文，主任医师，博士；电子信箱：libaiwensh@163.com。
基金资助:
上海市科学技术委员会“科技创新行动计划”医学创新研究专项项目(23Y11902000);上海申康医院发展中心第二轮促进市级医院临床技能与临床创新三年行动计划（2023—2025年）临床研究数据共享和模拟RCT项目(SHDC2024CRI049);上海交通大学医学院“双百人”项目(20240813);上海交通大学“交大之星”计划医工交叉研究基金（智能医疗健康研究）(YG2023QNB17)

Review of indication stratification and clinical strategies for endoscopic ultrasound-guided pancreatic duct drainage

Chang Yuxin, Li Baiwen(), Ni Jianbo()

Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201620, China

Received:2026-03-09 Accepted:2026-04-09 Online:2026-07-07 Published:2026-07-07
Contact: Ni Jianbo, E-mail: jianbo.ni@shgh.cn.
Li Baiwen, E-mail: libaiwensh@163.com.
Supported by:
Science and Technology Innovation Action Plan of Shanghai Municipal Science and Technology Commission(23Y11902000);Shanghai Hospital Development Center, the Second Round of the Three-Year Action Plan (2023—2025) for Promoting Clinical Skills and Clinical Innovation in Municipal Hospitals Clinical Research Data Sharing and Simulated RCT Project(SHDC2024CRI049);“Two-hundred Talents” Program of Shanghai Jiao Tong University School of Medicine(20240813);Fundamental Research Funds for Central Universities(YG2023QNB17)

摘要/Abstract

摘要：

超声内镜引导胰管引流术（endoscopic ultrasound‑guided pancreatic duct drainage，EUS-PD/EUS-PDD）是治疗性超声内镜应用于胰腺疾病领域的重要进展，主要用于内镜逆行胰胆胰管造影（endoscopic retrograde pancreatography，ERCP）失败或无法实施的症状性胰管梗阻患者。该术式可通过胃、十二指肠或术后肠袢经壁穿刺主胰管，完成导丝置入、瘘道扩张与支架置放，实现胰管减压及胰液引流重建。系统评价与Meta分析显示，EUS-PD总体技术成功率为84.8%，临床成功率为89.2%，总体不良事件发生率为18.1%；提示其疗效确切但风险仍不可忽视。EUS-PD的常见适应证包括胰腺外伤致胰管断裂、胰腺手术并胰管损伤、重症急性胰腺炎伴胰管断裂以及术后解剖改变等，并发症主要包括术后胰腺炎、出血、穿孔及支架相关功能障碍。该文围绕适应证分层、术式路径、关键技术、并发症管理、长期随访与再干预策略等方面构建证据链，旨在为我国消化内镜中心开展EUS‑PD提供可复制的临床决策框架。

关键词: 超声内镜, 胰管引流术, 慢性胰腺炎, 术后解剖改变, 会师技术

Abstract:

Endoscopic ultrasound-guided pancreatic duct drainage (EUS-PD/EUS-PDD) represents a major advancement in therapeutic endoscopy for pancreatic duct disorders. It is primarily indicated for patients with symptomatic pancreatic duct obstruction in whom endoscopic retrograde pancreatography (ERCP) has failed or is not feasible. The procedure involves transmural puncture of the main pancreatic duct via the stomach, duodenum, or postsurgical jejunal limb, followed by guidewire placement, tract dilation, and stent insertion to achieve ductal decompression and restoration of pancreatic juice drainage. Systematic reviews and meta-analyses have reported an overall technical success rate of 84.8%, a clinical success rate of 89.2%, and an overall adverse event rate of 18.1%, indicating substantial efficacy with non-negligible risks. The common indications for EUS-PD include pancreatic duct disruption due to pancreatic trauma, pancreatic duct injury associated with pancreatic surgery, pancreatic duct disruption secondary to severe acute pancreatitis, and surgically altered anatomy. Complications mainly include post-procedural pancreatitis, bleeding, perforation, and stent-related dysfunction. This review constructs an evidence chain covering indication stratification, procedural approaches, key techniques, complication management, long-term follow-up, and reintervention strategies, aiming to provide a reproducible clinical decision-making framework for the implementation of EUS-PD in endoscopic centers in China.

Key words: endoscopic ultrasound, pancreatic duct drainage, chronic pancreatitis, surgically altered anatomy, endoscopic ultrasound-guided rendezvous

中图分类号:

R445.1

常雨欣, 李百文, 倪建波. 超声内镜引导胰管引流术的适应证分层与临床策略述评[J]. 上海交通大学学报（医学版）, 2026, 46(7): 847-856.

Chang Yuxin, Li Baiwen, Ni Jianbo. Review of indication stratification and clinical strategies for endoscopic ultrasound-guided pancreatic duct drainage[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026, 46(7): 847-856.

图/表 4

图1 EUS-PD操作步骤分解图Note： A. EUS puncture; B. Guidewire insertion; C. Tract dilation; D. Stent placement.

Fig 1 Step-by-step illustration of the EUS-PD procedure

图2 EUS-PD适应证分层与入路选择决策图Note： MPD—main pancreatic duct; ERCP—endoscopic retrograde cholangiopancreatography; SAA—surgically altered anatomy; PJAS—pancreaticojejunostomy anastomotic stricture RAP—recurrent acute pancreatitis; AEs—adverse events.

Fig 2 Indication stratification and route selection algorithm for EUS-PD

表1 EUS‑PD代表性研究特征与结局汇总

Tab 1 Summary of the characteristics and outcomes of representative studies on EUS‑PD

Reference	Study design	n	Indication	Approach	TS/%	CS/%	FU/ month	Migration/Occlusion	Reintervention	Overall AE/%
François^[10] (2002)	Case series	4	MPD obstruction, pain	TMD	100.0	75.0	12.0	NR	NR	0
Matsunami^[40] (2018)	Single-center	30	ARP, PJAS, MPD stricture	TMD	83.3	92.0	23.0^①	24.0%	Median 3^②	NR
Falque^[41] (2021)	Single-center	27	CP or SAA	TMD	92.5	88.8	34.2^①	18.5%	7.4%	NR
Chandan^[49] (2020)	Meta-analysis	714	Mixed cohort	RV+TMD	84.8	89.2	Var	21.3%	15.2%	18.1
Tyberg^[50] (2020)	Operator cohort	56	Mixed cohort	RV+TMD	84.0	98.0	13.0^①	3.6%	3.6%	24.0
Tessier^[54] (2007)	Case series	36	CP, MPD dilation	TMD	92.0	69.0	14.5	NR	NR	14.0
Brauer^[55] (2009)	Case series	8	MPD obstruction	TMD	88.0	50.0	14.0	NR	NR	0
Barkay^[56] (2010)	Retrospective	21	Complex MPD disease	TMD	48.0	12.0	13.0	NR	NR	13.0

图3 EUS-PD两层风险模型：操作相关并发症与支架相关事件Note： AEs—adverse events.

Fig 3 Two-layer risk model for EUS-PD: procedure-related adverse events and stent-related events

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超声内镜引导胰管引流术的适应证分层与临床策略述评

Review of indication stratification and clinical strategies for endoscopic ultrasound-guided pancreatic duct drainage

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