合并十二指肠乳头旁憩室的胆胰疾病患者行经内镜逆行胰胆管造影的操作技巧

庄东海; 张锎

doi:10.3969/j.issn.1001-5256.2016.09.026

合并十二指肠乳头旁憩室的胆胰疾病患者行经内镜逆行胰胆管造影的操作技巧

DOI: 10.3969/j.issn.1001-5256.2016.09.026

庄东海,
张锎

山东省交通医院肝胆内镜科

详细信息

中图分类号: R657.4;R816.5
计量
- 文章访问数: 2204
- HTML全文浏览量: 9
- PDF下载量: 420
- 被引次数: 0
出版历程
- 出版日期: 2016-09-20

Operation skills of endoscopic retrograde cholangiopancreatography in pancreaticobiliary patients with periampullary duodenal diverticula

Department of Hepatobiliary Endoscopy, Shandong Jiaotong Hospita

摘要

摘要: 目的探讨合并十二指肠乳头旁憩室行经内镜逆行胰胆管造影术（ERCP）的操作技巧。方法回顾性分析2013年3月-2015年2月于山东省交通医院肝胆内镜科行ERCP合并十二指肠乳头旁憩室患者867例的临床资料,分析插管成功率、治疗效果及并发症发生情况。结果插管成功率99.8%,使用切开刀直接插管成功793例,采用双导丝及胰管支架占据44例,止血夹固定乳头法3例,预切开25例,2例未能成功插管。治疗过程中出现胰腺炎5例,穿孔1例,延迟性出血1例,经保守治疗后均治愈。结论 ERCP治疗合并十二指肠乳头旁憩室的胆胰疾病,应明确ERCP、内镜下乳头括约肌切开术适应证,根据乳头特点采用针对性的操作技巧,有助于提高成功率,减少并发症,是一种安全的微创治疗方法。
- 胆道疾病 /
- 胰腺疾病 /
- 憩室 /
- 胰胆管造影术,内窥镜逆行
Abstract: Objective To investigate the operation skills of endoscopic retrograde cholangiopancreatography( ERCP) in patients with periampullary duodenal diverticula. Methods A retrospective analysis was performed for the clinical data of 867 patients with periampullary duodenal diverticula who underwent ERCP in Department of Hepatobiliary Endoscopy in Shandong Jiaotong Hospital from March 2013 to February 2015. The rate of successful intubation,therapeutic effect,and development of complications were analyzed. Results The rate of successful intubation was 99. 8%. Of all patients,793 underwent successful intubation with an incision knife,44 were treated with double guide wires and pancreatic duct stenting,3 underwent fixation of the papilla with hemostatic clips,25 underwent the pre- cut technique,and 2underwent failed intubation. There were 5 cases of pancreatitis,l case of perforation,l case of delayed bleeding,and all the patients were cured after conservative treatment. Conclusion When ERCP is used in the treatment of pancreaticobiliary diseases complicated by periampullary duodenal diverticula,the indications for ERCP and endoscopic sphincterotomy should be clarified. Targeted operation skills selected based on the features of the papilla help to improve the success rate and reduce complications,and therefore,it is a safe minimally invasive therapy.
- biliary tract diseases /
- pancreatic diseases /
- diverticulum /
- cholangiopancreatography,endoscopic retrograde

HTML全文

参考文献(11)

[1]MIAO L,WANG F.Recent progress in ERCP for biliary and pancreatic diseases[J].J Clin Hepatol,2014,12(30):1259-1264.(in Chinese)缪林,王飞.经内镜逆行胰胆管造影在胆胰疾病中的应用[J].临床肝胆病杂志,2014,12(30):1259-1264.

[2]CHENG W,PENG C,JIANG B,et al.Thinking of diagnosis pattern of hepatolithiasis[J].Med Philosophy,2013,34(18):87-89.(in Chinese)成伟,彭创,蒋波,等.肝胆管结石诊断模式的思考[J].医学与哲学,2013,34(18):87-89.

[3]RAJNAKOVA A,GOH PM,NGOI SS,et al.ERCP in patients with periampullary diverticulum[J].Hepatogastroenterology,2003,50(51):625-628.

[4]ZOEPF T,ZOEPF DS,ARNOLD JC,et al.The relationship between juxtapapillary duodenal diverticula and disorders of the biliopancreatic system:analysis of 350 patients[J].Gastrointest Endosc,2001,54(1):56-61.

[5]MA SR.Operation methods of endoscopic retrograde cholangiopancreatography for diagnosis and treatment of pancreaticobiliary diseases[J].China Med News,2010,25(3):15-16.(in Chinese)麻树人.胆胰疾病诊治的ERCP相关操作方法[J].中华医学信息导报,2010,25(3):15-16.

[6] WEN W,WANG M,FAN ZN.The principle and clinical applicative value of double-wire technique in difficult ERCP[J].Chin J Dig Endosc,2009,26(11):599-600.(in Chinese)文卫,王敏,范志宁.双导丝技术在困难ERCP患者中的应用[J].中华消化内镜杂志,2009,26(11):599-600.

[7]MADCSY L,KURUCSAI G,FEJES R,et al.Prophylactic pancreas stenting followed by needle-knife fistulotomy in patients with sphincter of oddi dysfunction and difficult cannulation:new method to prevent post-ERCP pancreatitis[J].Dig Endosc,2009,21(21):8-13.

[8]WANG M,WANG GY,QIU W,et al.Efficiency analysis of precut sphincterotomy in ERCP with difficult cannulation[J].J Clin Hepatol,2012,28(1):14-16.(in Chinese)王蒙,王广义,邱伟,等.乳头扩约肌预切开术在困难插管内镜逆行胰胆管造影术中的疗效分析[J].临床肝胆病杂志,2012,28(1):14-16.

[9]YANG Z,MA SR.Diagnostic and therapeutic skills of ERCP on common cho Iangiopancreatic diseases[J].J Clin Hepatol,2014,28(2):84-87.(in Chinese)杨卓,麻树人.常见胆胰疾病经内镜逆行胰胆管造影诊治技巧[J].临床肝胆病杂志,2014,28(2):84-87.

[10]JI M,WANG YJ,YU L,et al.Endoscopic sphincterotomy plus balloon dilation for difficult bile duct stones[J].Chin J Dig Endosc,2010,27(11):568-571.(in Chinese)冀明,王拥军,俞力,等.十二指肠乳头括约肌小切开联合气囊扩张治疗难治性胆总管结石的疗效评价[J].中华消化内镜杂志,2010,27(11):568-571.

[11]LIU SP,FANG CH,DONG WG,et al.Effects of juxtapapillary duodenal diverticulu on endoscopic sphincterotomy in treating common bile duct stone and its complications[J].Chin J Clin Gastroenterol,2013,25(6):330-333.(in Chinese)刘少平,方春华,董卫国,等.十二指肠乳头旁憩室对内镜十二指肠乳头切开术治疗胆总管结石及其并发症的影响[J].临床消化病杂志,2013,25(6):330-333.

施引文献

资源附件(0)

访问统计