内镜下CCEST微创干预治疗胰胆管合流异常患者35例分析  

Treatment of pancreaticobiliary maljunction by minimally invasive endoscopic common channel sphinctertomy:Analysis of 35

作　　者：徐梦想 范震[2] 赵敏楠 Meng-Xiang Xu;Zhen Fan;Min-Nan Zhao(The Forth Clinical Medicine College,Zhejiang Chinese Medical University,Hangzhou 310053,Zhejiang Province,China;Department of Gastroenterology,Hangzhou First People’s Hospital,Hangzhou 310022,Zhejiang Province,China;The First People’s Hospital of Fuyang District,Hangzhou 311400,Zhejiang Province,China)

机构地区：[1]浙江中医药大学第四临床医学院,浙江省杭州市310053 [2]杭州市第一人民医院消化科,浙江省杭州市310022 [3]杭州市富阳区第一人民医院,浙江省杭州市311400

出　　处：《世界华人消化杂志》2024年第1期41-49,共9页World Chinese Journal of Digestology

基　　金：杭州市医药卫生科技项目,No.ZD20220041.

摘　　要：背景胰胆管合流异常(pancreaticobiliary maljunction,PBM)患者的共同通道(common channel,CC)过长导致Oddi括约肌的作用不直接影响到胰胆连接处,继而胰液和胆汁相互反流,造成胆道或胰腺的各种病理改变.探索内镜下微创缩短胰胆管CC通道在PBM中的应用及其机制变得尤为重要,为患者提供又一个治疗的技术选择.目的探讨经内镜下十二指肠乳头括约肌共同通道切开术(endoscopic common channel sphinctertomy,CCEST)微创干预治疗PBM患者的临床效果及安全性.方法观察分析CCEST内镜下微创干预治疗的35例PBM患者,其中BP型19例、PB型16例,复杂型0例.35例患者均行经内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)下CCEST并分析内镜下微创干预治疗对PBM患者的影响作用及并发症等情况.结果35例PBM患者中,男性12例,女性23例,平均年龄为(46±26.38)岁(3岁-89岁).所有患者均给予内镜下CCEST,以缩短共同通道.35例PBM患者中合并胆、胰管结石患者18例(51.43%),14例患者首次ERCP取石成功,成功率为78%(14/18).ERCP微创干预治疗术后1 wk,35例患者中血清生化、C-反应蛋白(C-reactive protein,CRP)指标及胆汁淀粉酶较术前均明显下降(P<0.05).5例患者出现轻度ERCP术后胰腺炎,经对症治疗后均未出现术后出血、消化道穿孔和重症胰腺炎等严重并发症.经过对35例患者(22.05±10.67)mo的随访,其中1例术后确诊胆管癌而行外科手术;有4例患者因结石复发再次行ERCP治疗,也取得满意疗效.治疗总有效率为88.6%(31/35).结论PBM起病较隐匿,ERCP可协助明确PBM诊断.CCEST通过缩短胆胰管汇合部共同通道,早期改善PBM患者胆胰管引流,是内镜微创治疗PBM患者的有效安全方法.BACKGROUND Patients with pancreaticobiliary maljunction(PBM)have a common channel(CC)that is too long,causing the Oddi sphincter not to directly affect the pancreaticobiliary junction.As a result,reflux between pancreatic juice and bile occurs,causing various pathological changes in the bile duct or pancreas.Exploring the application and mechanism of minimally invasive endoscopic shortening of the pancreatic bile duct CC channel in PBM has become particularly important,providing patients with another treatment option.AIM To investigate the clinical efficacy and safety of minimally invasive endoscopic common channel sphinctertomy(CCEST)in the treatment of patients with PBM.METHODS The clinical data of 35 PBM patients treated by minimally invasive CCEST were analyzed,and there were BP type(n=19)and PB type(n=16)PBM.All 35 patients underwent CCEST with the help of endoscopic retrograde cholangiopancreatography,and the therapeutic effects and complications of minimally invasive CCEST in PBM patients were analyzed.RESULTS A total of 35 patients were diagnosed with PBM,of whom 12 were male and 23 were female.The patients ranged in age from 3 to 89 years,with a mean age of(46±26.38)years.CCEST was performed in all patients to reduce the length of the CC.Among the 35 patients with PBM,18(51.43%)had combined biliary and pancreatic duct stones and underwent intraoperative lithotripsy.First-time ERCP stone extraction was successful in 14 patients,with a success rate of 78%(14/18).One week after minimally invasive intervention therapy,the serum biochemistry and C-reactive protein(CRP)and bile amylase in the 35 patients showed a significant decrease compared to the preoperative levels(P<0.05).Post-ERCP pancreatitis was observed in five patients,but no serious complications such as postoperative bleeding,gastrointestinal perforation,and severe pancreatitis occurred after symptomatic treatment.After a mean follow-up period of(22.05±10.67)mo in the 35 patients,one patient was diagnosed with carcinoma of the bile duct and treat

关 键 词：胰胆管合流异常 内镜下十二指肠乳头括约肌共同通道切开术 胆胰疾病 微创治疗 

分 类 号：R657.4[医药卫生—外科学]