经内镜逆行胰胆管造影术在胰胆管合流异常诊治中的价值分析  

Value of endoscopic retrograde cholangiopancreatography in pancreaticobiliary maljunction

作　　者：李柯[1] 薛魁金[2] 常虹[1] 姚炜[1] 张耀朋[1] 闫秀娥[1] 黄永辉[1] Li Ke;Xue Kuijin;Chang Hong;Yao Wei;Zhang Yaopeng;Yan Xiu'e;Huang Yonghui(Department of Gastroenterology,Peking University Third Hospital,Beijing 100191,China;Department of Gastroenterology,The Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]北京大学第三医院消化内科,100191 [2]青岛大学附属医院消化内科,266003

出　　处：《中华消化内镜杂志》2021年第11期871-875,共5页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨胰胆管合流异常(pancreaticobiliary maljunction,PBM)及其相关疾病谱的临床特点,总结治疗性经内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)在该病诊治中的应用价值。方法收集2006年6月-2021年3月在北京大学第三医院消化内科因腹痛、黄疸、发热等症状入院行ERCP诊治的52例PBM患者的资料。总结PBM的临床特点、分型、相关疾病谱变化和ERCP诊治过程。结果52例PBM患者中,女性多见,常见临床表现为腹痛和黄疸,其中Ⅰ型20例、Ⅱ型25例、Ⅲ型7例,合并胆总管囊肿者占50.0%。从首次发病到我院明确诊断为PBM的时间跨度平均为12.2年,其中主要临床问题发生变化的有24例(46.2%)。共进行69例次ERCP操作,5例次患者失败(7.2%),PBM的困难插管率为34.6%(18/52),其中11例需借助高级插管技术,同期可比非PBM4275例ERCP的困难插管率为15.4%(657/4275),两者相比差异有统计学意义(χ^(2)=14.455,P<0.05)。患者行多种治疗性ERCP操作,包括内镜下十二指肠乳头切开术、胰管支架置入术、胆管和胰管结石取石术等,操作成功率为92.8%(64/69),ERCP术后胰腺炎的发生率为15.4%(8/52)。结论PBM患者的主要临床问题可能随时间发生变化。ERCP技术在PBM及相关疾病的诊治中发挥重要作用,但插管难度较大,术后并发症相对较高。Objective To explore the elinical characteristics of pancreaticobiliary maljunetion(PBM)and its disease spectrum,and to evaluate therapeutic endoscopic retrograde cholangiopancreatography(ERCP).Methods Data of 52 PBM patients who reeived therapeutic ERCP procedures for abdominal pain,jaundice and fever in Department of Gastroenterology of Peking University Third Hospital from June 2006 to March 2021 were collected.The clinical characteristics,typing,the change of disease spectrum and ERCP procedures were analyzed.Results Among 52 PBM patients,female was more common.Abdominal pain and jaundice were the most common clinical manifestations,among which 20 were type I,25 type I and 7 type M.Half patients had the choledochal cyst.The mean timespan from the first onset to the final diagnosis was 12.2 years.Twenty-four cases(46.2%)had changes in PBM disease spectrum.Among 69 ERCP procedures,5(7.2%)failed.Dificult cannulation rate was 34.6%(18/52),and 11 patients underwent advanced cannulation techniques,while it was 15.4%(657/4275)in the conterpart non-PBM patients in the same period,with signifcant dfference between them(χ^(2)=14.455,P<0.05).Multiple therapeutice ERCP techniques including endoscopie sphincterotomy,pancreatic stent placement,removal of stones from the duct were applied with the successful rate of 92.8%(64/69).The incidence of post ERCP panereatitis was 15.4%(8/52).Conclusion The chief clinical problem may bechanged over time in PBM patients.Although.ERCP plays an important role in PBM and its disease spectrum,there may be a higher rate of difcult cannulation and postoperative comnplications.

关 键 词：胰胆管造影术 内窥镜逆行 疾病特征 胰胆管合流异常 内镜治疗 

分 类 号：R657.4[医药卫生—外科学]