十二指肠镜治疗慢性胰腺炎-《中国微创外科杂志》

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Title:: Duodenoscopy for the Treatment of Chronic Pancreatitis

作者:: 杨建锋; 张啸; 张筱凤; 郭英辉; 吕文; 林秀英; 杭州市第一人民医院消化内科，杭州310006

Author(s):: Yang Jianfeng; Zhang Xiao; Zhang Xiaofeng; et al.; Department of Gastroenterology, First People’s Hospital of Hangzhou, Hangzhou 310006, China

关键词:: 慢性胰腺炎; 十二指肠镜; 诊断; 治疗

Keywords:: Chronic pancreatitis; Duodenoscopy; Diagnosis; Therapy

分类号:: R657.5

文献标志码:: A

摘要:: 目的探讨十二指肠镜手术在慢性胰腺炎中的治疗作用。方法2000年1月~2006年12月，我院共经十二指肠镜治疗67例慢性胰腺炎。19例仅有乳头狭窄而胰管扩张不明显者，先行十二指肠乳头括约肌切开（EST）；48例胰管扩张者同时做EST和胰管括约肌切开(EPS)。21例胆总管下段狭窄者置入胆管塑料内支架（ERBD），38例胰管有明显狭窄者置入胰管塑料内支架（ERPD），其中同时置入胆胰管双支架12例。27例胰管结石者先行EPS后用探条扩张狭窄段，再用网篮或气囊取石，若取石困难则做ERPD，平均每3个月复查一次ERCP并取石，若仍未取出则再置入内支架。结果插管成功完成ERCP诊治62例，插管成功率92.5%（62/67）。60例术后腹痛消失或缓解，治疗有效率为96.8%(60/62)，2例无效，术后腹痛无缓解，均为胰管多处狭窄，内支架置入失败。21例ERBD、38例ERPD患者腹痛症状术后明显缓解，平均随访39.5月（5～70个月），症状未复发。27例胰管结石中19例取出。术后并发一过性高淀粉酶血症15例，急性胰腺炎5例，出血3例，无穿孔发生，无中转手术或死亡。结论十二指肠镜手术是慢性胰腺炎的首选治疗措施，具有安全、有效、创伤小的优点，多种治疗方法联合应用可提高治疗效果。

Abstract:: ObjectiveTo discuss the diagnostic and therapeutic value of duodenoscopy for chronic pancreatitis.Methods A total of 67 patients with chronic pancreatitis were treated with duodenoscopy in our hospital from January 2000 to December 2006. Among the patients, 19 patients who had duodenal papilla stenosis without obvious dilation of the pancreatic duct were treated with EST; 48 patients who had dilation of the pancreatic duct underwent EST combined with EPS. ERBD was performed on 21 patients who had stenosis of the inferior segment of the common bile duct, among which 12 received insertions of two stents into the biliary pancreatic duct. In 27 patients with stones in the pancreatic duct, the stenotic segment of the pancreatic duct was dilated after EPS, and then the stones were removed using basket or balloon. Afterwards, ERPD was performed if necessary. These patients were followed up with ERCP every 3 months, stents were used if necessary. ResultsDuodenoscopy was completed in 62 of the 67 patients with a success rate of 92.5% (62/67). Abdominal pain disappeared or markedly relieved in 60 cases after the treatment showing an effective rate of 96.8% (60/62). The operation was ineffective in 2 patient, who had no relief of their abdominal pain. The failure of stent insertion was due to the multiple stenosis of the pancreatic duct. Abdominal pain was markedly relieved in 21 patients who received ERBD and 38 patients who underwent ERPD. During a 39.5month followup (5-70 months), no recurrence of the symptom was found. In the 27 patients with stones in the pancreatic duct, the stones were removed in 19 patients. After the treatment, 15 patients developed transient hyperamylasemia, 5 had acute pancreatitis, 3 had hemorrhage. No perforation, conversion to an open surgery, or death occurred in this series.Conclusions Duodenoscopy, which is safe, effective, and minimally invasive, is the first choice for chronic pancreatitis. The treatment outcomes can be improved by combining duodenoscopy with other therapies.

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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

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