内镜逆行胰胆管造影术诊治胰胆汇合异常

外科理论与实践››2021,Vol. 26››Issue (02): 163-166.doi:10.16139/j.1007-9610.2021.02.014

内镜逆行胰胆管造影术诊治胰胆汇合异常

周海斌¹, 金杭斌², 黄海涛², 杨晶², 吕文², 张筱凤², 杨建锋²()

1.浙江大学医学院附属杭州市第一人民医院（城北院区）消化内科,浙江杭州 310022
2.浙江大学医学院附属杭州市第一人民医院消化内科,浙江杭州 310006

收稿日期:2020-09-30出版日期:2021-03-25发布日期:2022-07-27
通讯作者:杨建锋 E-mail:yjf3303@zju.edu.cn
基金资助:
浙江省医药卫生科技计划项目(2019RC068);浙江省医药卫生科技计划项目(2020KY702);杭州市医药卫生科技项目(A20200132)

Endoscopic retrograde cholangiopancreatography in diagnosis and treatment of pancreaticobiliary maljunction

ZHOU Haibin¹, JIN Hangbin², HUANG Haitao², YANG Jing², LÜ Wen², ZHANG Xiaofeng², YANG Jianfeng²()

1. Department of Gastroenterology, Affiliated Hangzhou First People's Hospital (North Campus), Zhejiang University School of Medicine, Zhejiang Hangzhou 310022, China
2. Department of Gastroenterology Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Zhejiang Hangzhou 310006, China

Received:2020-09-30Online:2021-03-25Published:2022-07-27
Contact:YANG Jianfeng E-mail:yjf3303@zju.edu.cn

摘要/Abstract

摘要：

目的：探讨内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography,ERCP）诊治胰胆汇合异常（pancreaticobiliary maljunction, PBM）的疗效及安全性。方法：收集浙江大学医学院附属杭州市第一人民医院2007年12月至2020年8月经ERCP诊治的PBM病人,分析PBM临床表现、ERCP治疗、术后并发症发生情况。结果：共检出219例PBM病人,男95例,女124例,平均年龄（52.11±23.32）（2~89）岁。术前以腹痛为主要临床表现（77.93%）。ERCP插管成功率为98.17%（215/219）,治疗缓解率为96.80%（212/219）。共23例次（7.93%）出现术后并发症,均经保守治疗痊愈。结论：PBM女性略多于男性,腹痛为主要症状。经ERCP治疗PBM引发的胆胰疾病疗效良好且安全性高。

关键词:内镜逆行胰胆管造影术,胰胆汇合异常,急性胰腺炎

Abstract:

ObjectiveTo investigate the effect and safety of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and treatment of pancreaticobiliary maljunction (PBM).MethodsThe patients with PBM were diagnosed and treated using ERCP and included from December 2007 to August 2020 in Hangzhou First People's Hospital of Zhejiang University School of Medicine. The clinical manifestations of PBM, ERCP treatment, and post ERCP complications were analyzed.ResultsA total of 219 patients with PBM were in this study including 95 males and 124 females with an average age of (52.11±23.32) (2-89) years. Abdominal pain (77.93%) was the main clinical manifestations of PBM. The success rate of endoscopy intubation was 98.17% (215/219), and the cases with curative ERCP was 96.80% (212/219). Twenty-three of ERCP(7.93%) had post ERCP complications cured all by conservative treatment.ConclusionsPBM is more common in women with main manifestation of abdominal pain. ERCP is effective and safe for biliary and pancreatic diseases induced by PBM.

Key words:Endoscopic retrograde cholangiopancreatography,Pancreaticobiliary maljunction,Acute pancreatitis

中图分类号:

R657.4

周海斌, 金杭斌, 黄海涛, 杨晶, 吕文, 张筱凤, 杨建锋. 内镜逆行胰胆管造影术诊治胰胆汇合异常[J]. 外科理论与实践, 2021, 26(02): 163-166.

ZHOU Haibin, JIN Hangbin, HUANG Haitao, YANG Jing, LÜ Wen, ZHANG Xiaofeng, YANG Jianfeng. Endoscopic retrograde cholangiopancreatography in diagnosis and treatment of pancreaticobiliary maljunction[J]. Journal of Surgery Concepts & Practice, 2021, 26(02): 163-166.

图/表1

参考文献18

[1]	Hyvärinen I, Hukkinen M, Kivisaari R, et al. Increased prevalence of pancreaticobiliary maljunction in biliary malignancies[J]. Scand J Surg, 2019, 108(4):285-290. doi:10.1177/1457496918822617pmid:30630392
[2]	胡冰, 周岱云, 吴萍, 等. 先天性胆胰管合流异常与胆囊癌的关联[J]. 中华消化内镜杂志, 2004, 21(4):8-11.
[3]	李鹏, 王拥军, 王文海. 中国ERCP指南(2018版)[J]. 中华消化内镜杂志, 2018, 35(11):777-813.
[4]	Cui GX, Huang HT, Yang JF, et al. Rare variant of pancreaticobiliary maljunction associated with pancreas divisum in a child diagnosed and treated by endoscopic retrograde cholangiopancreatography: a case report[J]. World J Clin Cases, 2019, 7(9):1073-1079.
[5]	Wang Q, Moon SB, Zang J, et al. Usefulness of pre-ope-rative endoscopic retrograde cholangiopancreatography in diagnosis and management of forme fruste choledochal cyst in children[J]. ANZ J Surg, 2020, 90(6):1041-1045.
[6]	汪健, 郭万亮. 儿童胰胆管合流异常诊断及治疗[J]. 肝胆外科杂志, 2012, 20(6):470-471.
[7]	吕涛, 张筱凤. 内镜下逆行胰胆管造影术在儿童胰腺疾病中的应用分析[J]. 中华儿科杂志, 2013, 51(5):367-370.
[8]	Kamisawa T, Kuruma S, Chiba K, et al. Biliary carcinogenesis in pancreaticobiliary maljunction[J]. J Gastroenterol, 2017, 52(2):158-163. doi:10.1007/s00535-016-1268-zpmid:27704265
[9]	Kamisawa T, Honda G. Pancreaticobiliary maljunction: markedly high risk for biliary cancer[J]. Digestion, 2019, 99(2):123-125. doi:10.1159/000490816pmid:30179869
[10]	周进学, 李臻, 韩新巍, 等. 胰胆管汇合异常与胆道癌的关系[J]. 中华肝胆外科杂志, 2011, 17(4):341-343.
[11]	周进学, 李臻, 韩新巍, 等. 胰胆管汇合异常与胆道癌的相关性研究[J]. 中国肿瘤临床, 2010, 37(15):879-881.
[12]	Kamisawa T, Funata N, Hayashi Y, et al. Pathologic changes in the non-carcinomatous epithelium of the gallbladder in patients with a relatively long common channel[J]. Gastrointest Endosc, 2004, 60(1):56-60. pmid:15229426
[13]	Kamisawa T, Tu Y, Egawa N, et al. MRCP of congenital pancreaticobiliary malformation[J] Abdom Imaging, 2007, 32(1):129-133. pmid:16680507
[14]	韩新巍, 李臻, 吴刚. 经皮肝穿刺胆道造影诊断胰胆管合流异常的价值[J]. 中华放射学杂志, 2008, 42(8):797-801.
[15]	Zeng JQ, Deng ZH, Yang KH, et al. Endoscopic retrograde cholangiopancreatography in children with symptomatic pancreaticobiliary maljunction: a retrospective multicenter study[J]. World J Gastroenterol, 2019, 25(40):6107-6115.
[16]	Jin Z, Bie LK, Tang YP, et al. Endoscopic therapy for patients with pancreaticobiliary maljunction: a follow-up study[J]. Oncotarget, 2017, 8(27):44860-44869.
[17]	Hiramatsu T, Itoh A, Kawashima H, et al. Usefulness and safety of endoscopic retrograde cholangiopancreatography in children with pancreaticobiliary maljunction[J]. J Pe-diatr Surg, 2015, 50(3):377-381.
[18]	周海斌, 杨建锋, 张啸, 等. 浙江省ERCP人群特点及疾病趋势的初步研究[J]. 中华消化内镜杂志, 2019, 36(6):402-406.