十二指肠乳头生理性过长致胆胰管梗阻病变的内镜诊断与治疗  

Role of endoscope in diagnosis and treatment of the pancreatobiliary obstructive diseases induced by physiologically overlengthed papilla

作　　者：王爱东[1] 陈志红[2] 张法标[1] 杨健[1] 张财明[1] 吕尚东[1] 龚彪[3] 方哲平[1] 

机构地区：[1]浙江省台州医院肝胆外科,浙江台州317000 [2]浙江省台州医院服务中心,浙江台州317000 [3]上海交通大学附属瑞金医院消化科,上海200025

出　　处：《肝胆胰外科杂志》2011年第1期15-17,共3页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的报告导致胆胰管梗阻病变的少见因素十二指肠乳头生理性过长的临床特征以及内镜诊断与治疗价值。方法回顾性分析我科2004年2月至2010年6月间2 150例ERCP患者中10例特殊胆胰管梗阻病例的诊疗情况,对其及对照组40例胃镜检查者行乳头长度测量。结果 10例患者除十二指肠乳头外观过长、7例胆总管轻中度扩张外,ERCP术中未见有术前诊断病变。乳头测量长度(19.7±3.9)mm,对照组乳头长度(9.5±2.6)mm,差异有统计学意义(t=9.78,P<0.001)。10例经内镜乳头括约肌切开(EST)和鼻胆管引流(ENBD)后,症状消失。术后高淀粉酶血症2例,出血1例,经禁食、输液和内镜下止血治愈。结论十二指肠乳头生理性过长是导致胆胰管梗阻的较罕见因素,在复发性、特发性胰腺炎及某些胆道梗阻时应想到其存在的可能,内窥镜及ERCP可明确诊断及实施有效治疗。Objective To report the clinical characters of physiologically overlengthed papilla resulted in the pancreatobiliary ducts obstruction,and the value of endoscope in the diagnosis and treatment on it.Methods From Feb 2004 to June 2010,2 150 ERCPs were done in our department,among which 10 cases were special and different in diagnosis between clinical and ERCP.The clinical data of the 10 cases,including three recurrent pancreatitis,four ampullar occupied and three enlarged CBD or suspected CBD stone were analyzed retrospectively.The papilla lengths of this 10 cases and another 40 cases of control group without pancreatobiliary diseases were measured under endoscope.Results During ERCP,nothing but CBD dilation was found in 7 cases and overlengthed papilla were found in all of the 10 cases.The diameter of CBD was 11~16 mm（mean 12.2±2.5 mm）.The papilla length of the 10 cases was 16~29 mm（mean 19.7±3.9 mm）,and that of the control group was 3~15 mm（mean 9.5±2.6 mm,t=9.78,P0.001）.In the 10 cases,clinical symptoms were disappeared after EST or ENBD,with the complications of one bleeding and two hyperamylase.Two biopsy and one brushing were done for pathology,no tumor was found.After 6~37 months follow-up,there was no recurrence.Conclusion Physiologically overlengthed papilla is a rare factor which may cause this type of pancreatobiliary obstruction,it must to be considered in some idiopathic pancreatitis,recurrent pancreatitis and cholangiopancreatic obstructive cases,ERCP is an effective method both in diagnosis and treatment.

关 键 词：内窥镜 十二指肠乳头 内镜逆行胰胆管造影术 内镜乳头括约肌切开术 

分 类 号：R657.4[医药卫生—外科学]