内镜逆行胰胆管造影联合胆管支架治疗胆总管囊肿切除术后慢性胰腺炎  

Effect of endoscopic retrograde cholangiopancreatography combined with biliary stent in the treatment of chronic pancreatitis after choledochal cyst resection

作　　者：王晓亮 张诚 张昊 何川琦 周志杰 杨玉龙 WANG Xiaoliang;ZHANG Cheng;ZHANG Hao;HE Chuanqi;ZHOU Zhijie;YANG Yulong(Department of General Surgery,Pudong Hospital Affiliated to Fudan University,Shanghai 201399,China;Center of Gallstone Disease,Shanghai East Hospital Affiliated to Tongji University,Shanghai 200120,China)

机构地区：[1]复旦大学附属浦东医院普通外科,上海201399 [2]同济大学附属东方医院胆石病中心/同济大学医学院胆石病研究所,上海200120

出　　处：《肝胆胰外科杂志》2024年第8期486-490,共5页Journal of Hepatopancreatobiliary Surgery

基　　金：上海市浦东新区卫生健康委员会人才培养计划(PWR12022-4)。

摘　　要：目的 评估内镜逆行胰胆管造影(ERCP)联合胆管支架治疗胆总管囊肿切除术后慢性胰腺炎(CP)的效果。方法 回顾性分析2019年1月至2023年12月复旦大学附属浦东医院普通外科及同济大学附属东方医院胆石病中心采取ERCP治疗胆总管囊肿切除术后CP的35例患者临床资料,总结治疗体会。结果35例CP患者中,经ERCP诊断为高位胰胆合流异常(PBM)27例,其中胆总管残端结石合并胆管括约肌狭窄20例,单纯性胆管括约肌狭窄5例,胰管狭窄2例;经ERCP诊断为低位PBM 8例,其中乳头括约肌狭窄5例,胰管括约肌狭窄2例,胰管括约肌狭窄并胰管结石1例。35例先行ERCP治疗,结石取净2例,未取净19例;狭窄解除8例,未解除27例。后置入胆管支架,其中22例狭窄置入全覆膜金属支架(FCMS),5例狭窄置入塑料支架。术后腹痛缓解率100%(35/35),急性胰腺炎发生率5.7%(2/35),高淀粉酶血症发生率14.3%(5/35)。27例支架留置3~7个月后均成功取出,狭窄解除率92.6%(25/27),其中FCMS狭窄解除率100%(22/22),塑料支架狭窄解除率60%(3/5);19例结石取净率100%(19/19),其中结石消失率63.2%(12/19),结石溶解率100%(19/19)。术后随访4~63个月,胰腺炎复发率11.4%(4/35),再次接受ERCP治疗,均存在胰管狭窄,重新留置胰管支架。结论 结石和狭窄是胆总管囊肿切除术后CP的主要病因,ERCP置入FCMS不仅能解除狭窄,还能促进结石的溶解和排出。objective To evaluate the effect of endoscopic retrograde cholangiopancreatography(ERCP)combined with biliary stent in the treatment of chronic pancreatitis(CP)after choledochal cyst resection.Methods The clinical data of 35 CP patients after choledochal cyst resection,who treated with ERCP between Jan.2019 and Dec.2023 in Shanghai Pudong Hospital and Shanghai East Hospital,was retrospectively analyzed,and the treatment experience was summarized.Results Among the 35 CP patients,27 cases were diagnosed as high pancreaticobiliary maljunction(PBM)by ERCP,including 20 cases of common bile duct stump stones with bile duct sphincter stricture,5 cases of simple bile duct sphincter stricture,and 2 cases of pancreatic duct stricture;the remaining 8 cases were diagnosed as low PBM,including 5 cases of papillary sphincter stricture,2 cases of pancreatic sphincter stricture,and 1 case of pancreatic sphincter stricture with pancreatic duct stones.All patients were treated with ERCP,2 cases were stone free,8 patients were relieved of stricture.Among 27 patients with unresectable stricture,22 cases of stricture with fully covered metal stents(FCMS)and 5 cases of stricture with plastic stents.The postoperative abdominal pain relief rate was 100%(35/35),the incidence rate of acute pancreatitis was 5.7%(2/35),and the incidence rate of hyperamylasemia was 14.3%(5/35).After 3-7 months of indwelling,the stents were successfully removed in all 27 patients,the stricture relief rate was 92.6%(25/27),100%(22/22)for FCMS and 60%(3/5)for plastic stents;the stone clearance rate of 19 cases was 100%(19/19),in which the stone disappearance rate was 63.2%(12/19),and the stone dissolution rate was 100%(19/19).During the follow-up of 4-63 months,the recurrence rate of pancreatitis was 11.4%(4/35).After repeat ERCP treatment,pancreatic duct stricture was found in all patients,and pancreatic duct stents were replaced.Conculsion Stones and stricture are the main causes of CP after choledochal cyst resection.ERCP with FCMS can not only relieve the s

关 键 词：内镜逆行胰胆管造影 胆总管囊肿切除术 慢性胰腺炎 全覆膜金属支架 胰管狭窄 胰管结石 

分 类 号：R657.4[医药卫生—外科学]