内镜逆行胰胆管造影在闭合性胰腺损伤诊疗中的应用(附10例报告)  

Endoscopic retrograde cholangiopancreatography(ERCP)-based operation in treating blunt pancreatic trauma:A report of 10 cases

作　　者：赵铭宁[1] 吴文广[1] 陶怡菁 张文杰[1] 顾钧[1] 王雪峰[1] 

机构地区：[1]上海交通大学医学院附属新华医院普外科上海交通大学医学院胆道疾病研究所,上海200092

出　　处：《中国实用外科杂志》2014年第6期552-555,共4页Chinese Journal of Practical Surgery

摘　　要：目的探讨ERCP在胰腺闭合性损伤治疗中的作用。方法回顾性分析上海交通大学医学院附属新华医院2006年8月至2011年12月间收治的采用内镜逆行胰胆管造影(ERCP)治疗的10例胰腺闭合性损伤临床病例资料。按AAST胰腺损伤分级:Ⅰ级1例,Ⅱ级3例,Ⅲ级4例,Ⅳ级2例。结果 10例病人经治疗均存活。Ⅰ、Ⅱ级4例置鼻胰管胰液引流,均痊愈出院。Ⅲ级者4例,予置入胰管支架处理,其中1例增强CT显示胰周积液,行内镜超声经胃穿刺引流术,恢复顺利;2例术后复查CT出现胰腺假性囊肿,行B超定位穿刺引流后痊愈。Ⅳ级2例联合留置胰管与胆管支架治疗,其中1例胰周出现积液,在B超引导下穿刺引流术后痊愈。全组胆管支架与胰管支架均在术后3个月后再次住院取出。结论应严格把握胰腺闭合性损伤ERCP治疗的适应证,ERCP治疗的策略应基于胰腺损伤分级,包括临床评估、CT及ERCP影像评估。Objective To evaluate the role of endoscopic retrograde cholangiopanereatography （ERCP） in treating blunt pancreatic trauma（BPT）. Methods The clinical data of 10 cases of BPT undetv4ent ERCP-bascd management between August 2006 and December 2011 in Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were analyzed retrospectively. The pancreatic injuries were assessed with the American Association for the Surgery of Trauma （ASST） grading system. Pancreatic injuries in l0 cases were graded including 1 ease of grade Ⅰ, 3 of grade Ⅱ , 4 of grade Ⅲ and 2 of grade Ⅳ. Results Ten cases of BPT all survived after ERCP-based treatment. Four cases of grade Ⅰ/ Ⅱ injury were cured after endoscopic naso-pancreatic drainage. Four with grade Ⅲ injury were placed with pancreatic stent, in which one underwent endoscopic ultrasound （EUS）-guidcd transgastric drainage of peripancreatic fluid detected by contrast-enhanced CT, and two developed pancreatic pseudocyst identified by postoperative CT and cured by EUS-guided transgastric puncture. Two cases of grade Ⅳ injury were treated by concurrent placement of pancreatic stent and biliary stent, including one cured by EUS-guided puncture and drainage of peripancreatie fluid. All the stents were dislodged 3 months after implantation. Conclusion ERCP-based treatment for BPT depends on strict control of indications. Therapeutic strategy of ERCP should be established on the grade ofpancreatic injury which is determined by clinical assessment, CT and ERCP imaging comprehensively.

关 键 词：胰腺闭合性损伤 分级 内镜逆行胰胆管造影 

分 类 号：R6[医药卫生—外科学]