ERCP治疗胰管结石  

Endoscopic retrograde cholangio-pancreatography for pancreatic duct stones

作　　者：尹振宇 刘乾 李晓梅 齐文博 刘乐[1] 白玉萍 陈昊[2] Yin Zhenyu;Liu Qian;Li Xiaomei;Qi Wenbo;Liu Le;Bai Yuping;Chen Hao(Lanzhou University Second Hospital,Lanzhou 730030,China;Department of Surgical Oncology,Lanzhou University Second Hospital,Lanzhou 730030,China)

机构地区：[1]兰州大学第二临床医学院,730030 [2]兰州大学第二医院肿瘤外科,730030

出　　处：《中华肝脏外科手术学电子杂志》2020年第5期466-470,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：国家自然科学基金(81670594);甘肃省科技重大专项(19ZD2WA001);甘肃省重点人才项目(2019RCXM020);兰州市城关区科技计划项目(2019RCCX0034)。

摘　　要：目的探讨ERCP治疗胰管结石(PDS)的疗效及安全性。方法回顾性分析2019年10月在兰州大学第二医院行ERCP治疗的1例PDS患者临床资料。患者签署知情同意书,符合医学伦理学规定。患者男,72岁。因"上腹部不适10 d"于2019年10月23日入院。查体:全身皮肤及巩膜无黄染,上腹压痛,无反跳痛,Murphy征阴性,肠鸣音3次/min。既往有2型糖尿病史10年,慢性胰腺炎史多年。入院血糖16.7 mmol/L。CT、MRI、MRCP诊断PDS。患者于2019年10月28日行ERCP治疗。结果 ERCP下行十二指肠乳头括约肌切开,采用柱状球囊扩张胰管开口及近端胰管,采用球囊清理白色泥沙样结石,沿导丝支架放置7.5 cm胰管支架,并在胆管内放置胆管塑料支架,见胆汁及胰液排泄通畅。术后给予抗炎等对症支持治疗,患者好转出院。患者术后恢复良好,饮食正常,无腹痛,血糖控制良好。术后3个月复查CT示胰管通畅,结石无复发。术后6个月随访患者恢复良好。结论应根据PDS发生部位、大小、数量,以及胰管解剖形态变化情况采用精准个体化治疗。当主胰管内有1个结石时,ERCP取石术并放置胰管支架是最佳的选择。Objective To evaluate the efficacy and safety of endoscopic retrograde cholangio-pancreatography (ERCP) in the treatment of pancreatic duct stones (PDS).Methods Clinical data of one PDS patient treated with ERCP in Lanzhou University Second Hospital in October 2019 were retrospectively analyzed.The informed consent of this patient was obtained and the local ethical committee approval was received.The male patient,aged 72 years old,was admitted to hospital on October 23,2019 due to "upper abdominal discomfort for 10 d".No skin and sclera yellowing,upper abdominal tenderness were found in physical examination without rebound pain,Murphy sign,and bowel sounds was 3 times/min.He had a history of type 2 diabetes mellitus for 10 years and chronic pancreatitis for years.Upon admission,the blood glucose level was 16.7 mmol/L.PDS was diagnosed by CT,MRI and MRCP.ERCP was performed on October 28,2019.Results Under ERCP,the duodenal papilla sphincterotomy was performed,and the pancreatic duct opening and proximal pancreatic duct were dilated by cylindrical balloon.White silt-like stones were cleaned up with balloon cleaning.A 7.5-cm pancreatic duct stent was placed along the guidewire stent,and a plastic stent was placed in the bile duct.The bile and pancreatic fluid could be excreted smoothly.After the operation,the patient received anti-inflammation and symptomatic treatments,and then discharged.The patient recovered well after operation and maintained normal diet without abdominal pain,and the blood glucose level was properly controlled.CT reexamination at postoperative 3 months showed that the pancreatic duct was unobstructed and no recurrence of PDS.The patient recovered well at postoperative 6-month follow-up.Conclusions Precise individualized treatments should be adopted according to the location,size and quantity of PDS,as well as the anatomical changes of pancreatic duct.ERCP lithotripsy with stent placement is the optimal choice for patients with one stone lesion in the main pancreatic duct.

关 键 词：胰管结石 胰胆管造影术 内窥镜逆行 

分 类 号：R657.4[医药卫生—外科学]