ERCP在慢性阻塞性胰腺炎中的治疗价值研究  

Study on the therapeutic value of ERCP in chronic obstructive pancreatitis

作　　者：李甫[1] 吉建梅 陈萌[2] 张晞文[1] 龚彪 余金钟 LI Fu;JI Jian-mei;CHEN Meng;ZHANG Xi-wen;GONG Biao;YU Jin-zhong(Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China)

机构地区：[1]上海中医药大学附属曙光医院胰胆外科,201203 [2]上海中医药大学附属曙光医院消化医学部内镜中心,201203

出　　处：《现代消化及介入诊疗》2020年第8期1000-1005,共6页Modern Interventional Diagnosis and Treatment in Gastroenterology

基　　金：国家自然科学基金(81904017);上海市科委“科技创新行动计划”临床医学领域项目(19401972400);上海中医药大学2017年“杏林青年学者”培养项目。

摘　　要：目的探讨内镜下行胰胆管造影术(ERCP)在慢性阻塞性胰腺炎中的治疗价值。方法收集2018年1月至2019年11月成功实施ERCP的63例符合纳入标准的慢性阻塞性胰腺炎患者,比较治疗前后患者的症状、生化指标和影像学变化。结果63例患者中含胃毕Ⅱ式术后4例、胰十二指肠术后3例、体外震波碎石术后6例,患者共接受134例次ERCP操作;术后较术前疼痛评分(6.3±2.7 vs 3.1±1.9)、脂肪泻(23.8%vs 9.5%)、胆道梗阻[总胆红素(89.3±37.2)μmol/L vs(43.2±18.4)μmol/L]、假性囊肿直径[(8.1±2.6)cm vs(3.9±2.1)cm]明显改善,胰管结石清除率82.6%(19/23),而术后血糖、糖化血红蛋白、胰管直径等无显著性变化。结论ERCP是解决胰管梗阻、改善胰管狭窄、清除胰管结石、提升胰腺分泌功能的有效措施,在慢性阻塞性胰腺炎的治疗中具有重要价值。Objective To investigate the therapeutic value of endoscopic retrograde cholangiopancreatography(ERCP)in chronic obstructive pancreatitis.Methods From January 2018 to November 2019,63 patients with chronic obstructive pancreatitis accepted ERCP who met the inclusion criteria were collected to compare their symptoms,biochemical indicators and imaging changes before and after treatment.Result Among the 63 patients,there were 4 cases after GastropexyⅡoperation,3 cases after pancreatoduodenectomy,6 cases after ESWL operation.All patients received 134 ERCP operations;postoperative pain score(6.3±2.7 vs 3.1±1.9),fat diarrhea(23.8%vs 9.5%),biliary obstruction(89.3±37.2 vs 43.2±18.4μmol/L),pseudocyst diameter(8.1±2.6 vs 3.9±2.1 cm)were significantly improved after operation.The removal rate of pancreatic duct stones was 82.6%(19/23).There were no significant changes in blood glucose,glycosylated hemoglobin and pancreatic duct diameter.Conclusion ERCP is an effective measure to solve the obstruction of pancreatic duct,improve the stricture of pancreatic duct,clear the calculus of pancreatic duct,and improve the secretion function of pancreas.It has an important value in the treatment of chronic obstructive pancreatitis.

关 键 词：ERCP 慢性胰腺炎 胰管阻塞 胰管支架 疗效分析 

分 类 号：R605[医药卫生—外科学] R576[医药卫生—临床医学]