经内镜逆行胰胆管造影联合SpyGlass在胆管内乳头状黏液性肿瘤诊断中的应用  

Endoscopic retrograde cholangiopancreatography combined with SpyGlass in the diagnosis of intraductal papillary mucinous neoplasms of the bile duct

作　　者：丁聪 杨建锋 金杭斌 周益峰[1] 顾页 沈红璋 张筱凤 Ding Cong;Yang Jianfeng;Jin Hangbin;Zhou Yifeng;Gu Ye;Shen Hongzhang;Zhang Xiaofeng(Department of Gastroenterologyy Affiliated Hangzhou First People's Hospital,Zhejiang University School of Medicine,Hangzhou 310000,China)

机构地区：[1]浙江大学医学院附属杭州市第一人民医院消化内科,310000

出　　处：《中华消化内镜杂志》2021年第11期925-928,共4页Chinese Journal of Digestive Endoscopy

基　　金：杭州市卫生科技计划项目(20162013A01)。

摘　　要：探讨经内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)联合SpyGlass内镜直视系统(简称SpyGlass)诊断胆管内乳头状黏液性肿瘤(intraductal papillary mucinous neoplasm of the bile duct,IPMN-B)的应用价值。回顾性分析杭州市第一人民医院2016年1月-2019年12月ERCP联合SpyGlass检查的IPMN-B 9例患者资料,分析其ERCP及SpyGlass特征、并发症、病理、预后等资料。9例IPMN-B最终诊断5例良性,4例恶性;成功实施ERCP 9例,SpyGlass技术成功8例。内镜见乳头开口黏液流出5例,ERCP球囊取出黏液8例。所有患者ERCP见胆管广泛扩张伴充盈缺损,SpyGlass见胆管内黏液。SpyGlass显示病变黏膜呈"鱼卵状无血管像"(Ⅱ型)3例,"鱼卵状伴血管像"(Ⅲ型)1例,"绒毛状"(Ⅳ型)4例,8例明确病变范围。1例SpyGlass发现病变累及肝内外广泛胆管,因此建议肝移植,避免外科手术探查。1例Ⅲ型病灶SpyGlass检查进行直视下活检,病理提示中度异型增生,与术后病理吻合。9例均无并发症发生。ERCP联合SpyGlass可明确IPMN-B病变范围,为后续手术方案选择提供依据,其诊断IPMN-B安全有效。To evaluate the value of endoscopie retrgrade cholangiopancreatography(ERCP)and SpyGlass in the diagnosis of intraductal papillary mucinous neoplasm of the bile duct(IPMN-B).Data of patients who underwent ERCP and SpyGlass in Hangzhou First People's Hospital from January 2016 to December 2019 were analyzed.ERCP and SpyGlass features,complications,clinicopathologic characteristics and prognosis were retrospectively analyzed.A total of 9 patients(5 benign lesions and 4 malignant lesions)were included.ERCP was successfully performed in 9 cases,while SpyGlass was technically successful in 8 cases.Endoscopy showed mucus outlow from the papilla in 5 cases,and the mucus was removed by the balloon of ERCP in 8 cases.ERCP showed bile duct diffuse dilatation and flling defects in all patients.SpyGlass found the mucus in the bile duct in all patients.SpyGlass showed lesion mucosa were fish-egg like without vascular images(Ⅱtype,3 cases),fish-egg like with vascular images(Ⅲ type,I case),villous(Ⅳ type,4 cases).SpyClass defined extent of the lesion in 8 cases.SpyClass found that the lesion involved the intra and extrahepatic bile ducts in one case.Therefore,liver transplantation was recommended to avoid surgical exploration.One type Ⅲ lesion underwent a direct biopsy.The pathology showed moderate dysplasia,which was consistent with the postoperative pathology.No complication occurred.ERCP combined with SpyClass could clarify the scope of IPMN-B and provide basis for surgical options,which is safe and efectve in IPMN-B diagnosis.

关 键 词：胰胆管造影术 内窥镜逆行 诊断 导管内乳头状黏液性肿瘤 并发症 

分 类 号：R735.8[医药卫生—肿瘤]