经内镜逆行胰胆管造影术在治疗合并消化道狭窄的胆胰疾病患者中的应用价值  

Value of endoscopic retrograde cholangiopancreatography in treatment of patients with biliary and pancreatic diseases with digestive tract stricture

作　　者：王维钊 向晓星[2] 刘军[1] 邓登豪[2] 王璐[1] 陈娟[2] 陈炜炜[2] 柴海娜[1] 孙超[1] 吴莹莹[1] 徐庆成 陈功 韩维维 陈超伍 倪修凡 任天棋 Wei-Zhao Wang;Xiao-Xing Xiang;Jun Liu;Deng-Hao Deng;Lu Wang;Juan Chen;Wei-Wei Chen;Hai-Na Chai;Chao Sun;Ying-Ying Wu;Qing-Cheng Xu;Gong Chen;Wei-Wei Han;Chao-Wu Chen;Xiu-Fan Ni;Tian-Qi(Ren Endoscopy Center,Subei People’s Hospital of Jiangsu Province,Yangzhou 225000,Jiangsu Province,China;Department of Gastroenterology,Subei People’s Hospital of Jiangsu Province,Yangzhou 225000,Jiangsu Province,China;Endoscopy Center,North Jiangsu People’s Hospital,Yangzhou 225000,Jiangsu Province,China)

机构地区：[1]江苏省苏北人民医院内镜中心,江苏省扬州市225000 [2]江苏省苏北人民医院消化内科,江苏省扬州市225000 [3]苏北人民医院内镜中心,江苏省扬州市225000

出　　处：《世界华人消化杂志》2021年第15期866-872,共7页World Chinese Journal of Digestology

摘　　要：背景随着目前医学诊疗技术的飞速发展,手术微创化,已成为疾病诊疗新趋势,而经过数十年的发展,经内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)已成为微创治疗胆胰疾病的首选手段之一,但是,当胆胰疾病合并消化道狭窄时,行ERCP难度往往较大,目前在该领域的研究较少,因此我们以此为中心展开研究.目的分析ERCP在治疗合并消化道狭窄的胆胰疾病患者中的应用价值.方法收集2014-01/2019-01我院ERCP治疗合并消化道狭窄的胆胰疾病患者临床资料,分析患者病例特点、狭窄处理方式、ERCP并发症情况,评估手术成功率及预后.结果4216例接受ERCP患者中,共有消化道狭窄(食管、胃、十二指肠狭窄)患者134例,其中食管胃吻合口狭窄13例(食管癌术后)、胃窦部狭窄1例(胃窦部巨大脂肪瘤)、十二指肠狭窄120例(恶性狭窄113例,良性狭窄7例).共有106例患者ERCP成功,整体成功率79.10%,包括11例食管吻合口狭窄,1例胃窦狭窄,94例十二指肠狭窄(良性7例,恶性87例).其中42例狭窄较轻患者经变换体位及上腹部压迫后通过狭窄段完成ERCP;31例通过更换JF十二指肠镜或胃镜进镜及导丝引导下完成手术;33例通过柱状气囊扩张后完成ERCP,其中9例在术后同时留置肠道支架;共有28例狭窄较重患者未能完成ERCP,2例为食管胃吻合口狭窄,26例为十二指肠球降部恶性狭窄.术中一例食管吻合口狭窄扩张后出血较多停止手术;术后6例患者在3-6 mo内因肿瘤浸润并十二指肠梗阻行肠道支架置入,2例因术后同时留置的肠道支架阻塞行肠道支架内清理扩张;无穿孔、重症胰腺炎等重大并发症.结论胆胰疾病合并消化道狭窄时,选取合适方法通过狭窄段后行ERCP仍是安全可行的:(1)对于食管癌术后狭窄,经食管扩张通过狭窄后常可完成ERCP,但需警惕食管狭窄扩张出血;(2)十二指肠球、降部狭窄较重患者ERCP难度�BACKGROUND With the rapid development of current medical diagnosis and treatment technology,minimally invasive surgery has become a new trend in disease diagnosis and treatment.After decades of development,endoscopic retrograde cholangiopancreatography(ERCP)has become one of the first choices for minimally invasive treatment of biliary and pancreatic diseases.However,when biliary and pancreatic diseases are combined with gastrointestinal stenosis,it is often difficult to perform ERCP.At present,there are few studies in this field.AIM To analyze the value of ERCP in the treatment of patients with biliary and pancreatic diseases with digestive tract stricture.METHODS From January 2014 to January 2019,the clinical data of patients with biliary and pancreatic disease combined with gastrointestinal strictures treated by ERCP at our hospital were collected,and case characteristics,stenosis management methods,and ERCP complications were recorded to evaluate the success rate and prognosis of the operation.RESULTS Among the 4216 patients receiving ERCP,there were 134 patients with gastrointestinal stenosis(stenosis of the esophagus,stomach,or duodenum),including 13 cases of esophagogastric anastomotic stenosis(post-esophageal cancer),1 case of gastric antrum stenosis(giant lipoma in the sinus),and 120 cases of duodenal stenosis(113 cases of malignant stenosis and 7 cases of benign stenosis).A total of 106 patients had successful ERCP,with an overall success rate of 79.10%,including 11 cases of esophageal anastomotic stenosis,1 case of gastric sinus,and 94 cases of duodenal stenosis(7 cases of benign and 87 cases of malignant).Among them,42 patients with mild stenosis completed the ERCPs after changing the position and compression of the upper abdomen;31 patients completed the operation by changing the JF duodenoscope or gastroscope and using the guide wire;33 patients completed ERCP after expansion with the cylindrical balloon,9 of whom underwent intestinal stenting at the same time after operation;and 28 patients with se

关 键 词：经内镜逆行胰胆管造影 消化道狭窄 胆胰疾病 

分 类 号：R657.4[医药卫生—外科学] R657.5[医药卫生—临床医学]