ERCP治疗胰管结石的临床分析

目的 分析经内镜逆行性胰胆管造影术(endoscopic retrograde cholangiopancreatography, ERCP)治疗胰管结石的适应证、临床效果及并发症。方法 选择2016年1月至2022年1月在郑州大学第一附属医院内镜中心诊治的35例胰管结石患者,分析取石成功率、并发症,随访术后6个月临床症状缓解情况。结果 35例患者共进行ERCP 53例次,取净结石21例,取石成功率60.0%。术中乳头出血1例,术后高淀粉酶血症6例,急性胰腺炎2例,术后6个月随访患者腹痛、脂肪泻等症状缓解,体质量增加。结论 ERCP治疗胰管结石是安全有效的,能减轻患者痛苦,改善临床症状。     

内镜下诊治伴发胰管结石慢性胰腺炎的价值

目的探讨ERCP在胰管结石诊断和治疗中的临床价值及其安全性评估。方法分析2008年2月～2008年10月期间共20例接受ERCP诊断和治疗的伴发胰腺结石慢性胰腺炎患者的临床资料。结果20例病例中,16例（80％）胰管结石位于胰头处,3例（15％）位于胰头及胰体处,1例（5％）累及全程胰管。14例（70％）患者一次性取石完全,5例患者术后接受体外震波碎石（ESWL）,1例患者未能完成取石,建议其外科手术治疗．18例表现为腹痛的病例,在接受内镜下治疗结石后,腹痛症状均消失,在接受治疗后2～10d内出院,平均（5．3±2．43）d。术后2例（10％）出现一过性的血淀粉酶升高。结论对于伴有胰管结石的慢性胰腺炎病例而青,内镜下取石是安全有效的方法,同时应川支架及鼻胰管引流,不仅对胰管结石的治疗有效,而且充分的胰液引流对于缓解腹痛症状、减少术后的胰腺炎、高淀粉酶m症的发乍有着重要的作用。     

胰管结石28例外科治疗

胰管结石临床上比较少见,正常人群发病率〈1％,其形成和发展与慢性胰腺炎（CP）互为因果。据统计,90％以上的酒精性CP合并胰管结石,20％～50％的CP在发病2年后形成胰管结石。结石所导致的胰管阻塞是临床出现腹痛、反复急性胰腺炎（AP）发作、胰腺内外分泌功能减退的重要原因。我院自2000年1月至2007年12月以来共收治胰管结石患者28例,均行手术治疗,取得较好疗效,现报告如下。     

胰管结石的手术治疗

胰管结石是慢性胰腺炎的并发症,临床上比较少见,正常人群发病率不超过1%,胰管阻塞是引起腹痛、消化道功能紊乱等症状的主要原因[1]。胰管结石伴慢性胰腺炎通常采用胰管切开取石、胰管空肠吻合术,但远期效果不佳,逆行反复慢性感染和癌变发生率高。全胰结石更加少见,治疗较困难。     

胰管空肠Roux—en—Y吻合术治疗胰管结石

胰管结石临床较为少见,发病率不超过1%。近年来,随着医学影像学的发展,胰管结石的病例明显增多,我院1990 年1月至2004年6月共收治胰管结石患者9例,行胰管切开取石、胰管空肠Roux-ez-Y吻合术8例。现报告如下。资料与方法一、一般资料本组8例中男6例,女2例。年龄14-66岁,平均年龄为42.6岁。病程1-6年。上腹部疼痛8例,脂肪泻和消瘦5例, 黄疸1例,糖尿病4例,反复消化道出血1例,上腹部压痛8 例,上腹部包块1例。     

胰管结石的诊断及治疗(附19例报告)

对19例胰管结石患者的临床资料作回顾性分析。临床表现主要为上腹痛,常伴有胆结石和胰腺其他疾病;B超、CT、内窥镜逆行胰胆管造影术（ERCP）、磁共振胰胆管造影术（MRCP）检查可确诊。保守治疗11例,腹痛消失或缓解9例;手术治疗8例,腹痛消失或缓解7例。认为胰管结石的诊断主要依据影像学检查,手术是有效的治疗方法。     

慢性胰腺炎合并胰管结石临床特点及治疗的探讨

目的 探讨慢性胰腺炎合并胰管结石临床特点及治疗方式.方法 我院及天津市南开医院2005年3月至2011年11月收治的慢性胰腺炎合并胰管结石患者30例进行回顾性分析.结果 长期酗酒和胆道疾病是慢性胰腺炎合并胰管结石的主要病因.上腹痛为最常见的临床表现.B超及CT为最常用的检查手段.2例胰管结石患者行手术治疗,18例胰管结石患者采用内镜治疗,效果满意.结论 慢性胰腺炎胰管结石的临床症状缺乏特异性,诊治比较复杂,目前手术仍然是最主要的手段,但应采取个体化手术方案.对于较局限的胰管结石,内镜治疗有其很大的优越性.     

胰管结石28例诊治体会

胰管结石是一种比较少见的胰腺疾病,在一般人群中的发病率不超过1％,但在慢性胰腺炎患者中的发病率却超过90％。1990～2003年．我院共收治胰管结石患者28例。现将诊治体会介绍如下。资料分析：本组28例中,男17例,女11例;年龄22～70岁,平均40.5岁。所有患者均有持续性腹部隐痛,并向后背部放射,有不同程度的食欲减退．体重减轻。上腹饱胀感;伴黄疽者3例,脂肪泻5例,腹部包块2例。28例患者中有明确慢性胰腺炎病史者16例。血尿淀粉酶升高者11例,血糖升高者4例。     

外科手术治疗胰管结石23例临床回顾

目的 探讨外科手术治疗胰管结石的疗效及手术方式的合理选择.方法 回顾性分析2003年1月～2010年1月间在我院收治的23例胰管结石病人的临床资料.结果 16例患者行胰管切开取石加胰管空肠Roux-en-Y吻合术(Partington手术),5例行胰十二指肠切除术,2例行胰体尾切除加脾切除术.无严重手术并发症及手术死亡...     

内镜下抽线式金属支架取出胰管结石——附3例报告

目的 设计抽线式胰管金属支架,以利于取出胰管结石.方法 收集3例确诊胰管结石并胰管远端狭窄,且ERCP取石失败者,应用十二指肠镜在主胰管置入抽线式金属支架,24 ～ 48 h后再次ERCP取石.结果 3例患者主胰管结石直径1 ～ 1.5 cm,造影显示胰管远端狭窄.先置入抽线式胰管金属支架,24 ～ 48 h后金属支架完全膨胀,插入气囊顺利取出全部结石,再将金属支架抽成丝样经活检孔取出.术后无出血、嵌顿、胰腺炎等并发症发生.结论 内镜下胰管内置入抽线式金属支架取石,安全、有效,费用低廉,增加了胰管取石的成功率.     

改良型一体式胰管支架在胰管狭窄中的应用

目的评估改良型一体式胰管支架置入治疗胰管狭窄的有效性和安全性。方法选取2018年6—12月在上海长海医院消化内镜中心因胰管狭窄,首次行经内镜逆行胰胆管造影术+胰管支架置入术的患者共200例,其中改良组（置入改良型一体式胰管支架）100例,传统组（置入传统胰管支架）100例。记录并分析手术一次成功率、胰管支架置入时间、医生及护士满意度评价及成本效益。结果改良组与传统组在一次手术成功率[100%(100/100)比78%(78/100)]、胰管支架置入时间 [(7.66±1.64)min比（34.11±15.32）min]、医师满意度[100%(100/100)比34%(34/100)]、护士满意度[100%(100/100)比23%(23/100)]及手术材料费[（5 817.12±548.09)元比(7 533.51±878.72)元]等方面,差异均有统计学意义（P均<0.05）。结论采用改良型一体式胰管支架置入治疗胰管狭窄,在治疗效果及成本控制上均明显优于传统方法,值得临床推广。     

内镜下抽线式金属支架取出胰管结石——附3例报告

目的设计抽线式胰管金属支架,以利于取出胰管结石。方法收集3例确诊胰管结石并胰管远端狭窄,且ERCP取石失败者,应用十二指肠镜在主胰管置入抽线式金属支架,24～48h后再次ERCP取石。结果3例患者主胰管结石直径1～1.5cm,造影显示胰管远端狭窄。先置入抽线式胰管金属支架,24～48h后金属支架完全膨胀,插入气囊顺利取出全部结石,再将金属支架抽成丝样经活检孔取出。术后无出血、嵌顿、胰腺炎等并发症发生。结论内镜下胰管内置入抽线式金属支架取石,安全、有效,费用低廉,增加了胰管取石的成功率。     

Extracorporeal shock wave lithotripsy for pancreatic and large common bile duct stones

Extraction of large pancreatic and common bile duct(CBD)calculi has always challenged the therapeutic endoscopist.Extracorporeal shockwave lithotripsy(ESWL)is an excellent tool for patients with large pancreatic and CBD calculi that are not amenable to routine endotherapy.Pancreatic calculi in the head and body are targeted by ESWL,with an aim to fragment them to<3 mm diameter so that they can be extracted by subsequent endoscopic retrograde cholangio-pancreatography(ERCP).In our experience,complete clearan...     

Clinical significance of main pancreatic duct dilation on computed tomography： Single and double duct dilation

AIM: To study the patients with main pancreatic duct dilation on computed tomography (CT) and thereby to provide the predictive criteria to identify patients at high risk of significant diseases, such as pancreatic cancer, and to avoid unnecessary work up for patients at low risk of such diseases. METHODS: Patients with dilation of the main pancreatic duct on CT at Emory University Hospital in 2002 were identified by computer search. Clinical course and ultimate diagnosis were obtained in all the identified patients by abstraction of their computer database records. RESULTS: Seventy-seven patients were identified in this study. Chronic pancreatitis and pancreatic cancer were the most common causes of the main pancreatic duct dilation on CT. Although the majority of patients with isolated dilation of the main pancreatic duct (single duct dilation) had chronic pancreatitis, one-third of patients with single duct dilation but without chronic pancreatitis had pancreatic malignancies, whereas most of patients with concomitant biliary duct dilation (double duct dilation) had pancreatic cancer. CONCLUSION: Patients with pancreatic double duct dilation need extensive work up and careful followup since a majority of these patients are ultimately diagnosed with pancreatic cancer. Patients with single duct dilation, especially such patients without any evidence of chronic pancreatitis, also need careful follow-up since the possibility of pancreatic malignancy, including adenocarcinoma and intraductal papillary mucinous tumors, is still high.     

Analysis of risk factors for pancreatic duct stones formation in patients with alcoholic chronic pancreatitis

BackgroundAlcoholic chronic pancreatitis (ACP) is the dominant cause of chronic pancreatitis (CP). As a main complication of CP, the formation of pancreatic duct stones (PDS) compromises pancreatic function and symptomatic patients are often subjected to aggressive treatments. The present study aimed to identify PDS risk factors in patients with ACP.MethodsA retrospective analysis of 93 ACP patients was performed; patients were divided into two groups: ACP with PDS (n = 48) and ACP without PDS (n = 45). Fourteen potential factors were analyzed by univariate and multivariate analyses to identify independent risk factors of PDS formation in ACP patients. A comparison of demographic and clinical characteristics between ACP patients with PDS and non-ACP patients with PDS (n = 43) was also carried out.ResultsACP accounted for 47.7% (93/195) of CP in this cohort. Among ACP patients, the morbidity of PDS was 51.6% (48/93). Significant risk factors of PDS formation for ACP patients included duration of drinking ≥24.7 years (OR, 9.036; 95% CI, 2.737–29.837; p < 0.001); daily alcohol consumption ≥147.0 g (OR, 3.147; 95% CI, 1.040–9.522; p = 0.042); and MPD narrowing (OR, 7.245; 95% CI, 2.205–23.811; p = 0.001). Shorter periods between diagnosis and PDS formation (PDP) were observed in ACP patients than non-ACP patients.ConclusionsAlcohol consumption accelerates the progression of PDS formation in patients with CP.     

Transpapillary incision of refractory circumscript pancreatic duct stricture using wire-guided snare forceps

Endoscopic therapy of pancreatic duct(PD)strictures using balloon dilation and pancreatic duct stent(PS) placement has been reported to improve the severity of abdominal pain in selected patients with chronic pancreatitis(CP).However,some strictures are refractory and require frequent PS exchange to control symptoms.We describe two cases of successful endoscopic PD incision for difficult PD stricture using a wireguided snare.The snare is partially opened within the strictured pancreatic duct while applying ...     

The endoscopic approach to pancreatic duct stones

Pancreatic duct stones may complicate the course of chronic pancreatitis and be responsible for recurrent episodes of pancreatitis and/or exacerbations of abdominal pain. Endoscopic management of pancreatic duct stones with or without extracorporeal shock-wave lithotripsy (ESWL) is a relatively safe and effective method to treat main pancreatic duct stones in symptomatic patients. Selection of candidates most likely to respond to endoscopic therapy needs further evaluation. Studies comparing medical, surgical, and endoscopic treatment of pancreatic duct stones are still awaited.     

Endoscopic pancreatic duct stent placement for inflammatory pancreatic diseases

The role of endoscopic therapy in the management of pancreatic diseases is continuously evolving; at present most pathological conditions of the pancreas are successfully treated by endoscopic retrograde cholangio- pancreatography （ERCP） or endoscopic ultrasound （EUS）, or both. Endoscopic placement of stents has played and still plays a major role in the treatment of chronic pancreatitis, pseudocysts, pancreas divisum, main pancreatic duct injuries, pancreatic fistulae, complications of acute pancreatitis, recurrent idiopathic pancreatitis, and in the prevention of post-ERCP pancreatitis. These stents are currently routinely placed to reduce intraductal hypertension, bypass obstructing stones, restore lumen patency in cases with dominant, symptomatic strictures, seal main pancreatic duct disruption, drain pseudocysts or fluid collections, treat symptomatic major or minor papilla sphincter stenosis, and prevent procedure-induced acute pancreatitis. The present review aims at updating and discussing techniques, indications, and results of endoscopic pancreatic duct stent placement in acute and chronic inflammatory diseases of the pancreas.     

胰管良恶性狭窄的内镜治疗

目的 探讨内镜治疗胰管狭窄的临床疗效。方法 36例影像学检查确诊的胰管狭窄患者,病因包括慢性胰腺炎、胰腺分裂症、胰头癌、胰腺假性囊肿等,分别在内镜逆行胰胆管造影基础上行内镜治疗,包括胰管支架置入、气囊扩张、探条扩张以及经内镜胰管括约肌切开术（EPS）、经内镜乳头括约肌切开术（EST）,同时观察术后症状缓解情况（如腹痛缓解率）、并发症发生率以及近期与远期疗效。结果36例分别进行了胰管支架引流术、气囊扩张、探条扩张、EPS和EST,术后腹痛症状有不同程度的改善,并发症发生率较低。随访1个月～36个月,平均15个月。术后近期（≤3个月）腹痛缓解率为72.2％（26/36）,长期（>3个月）随访显示47.2％（17/36）的患者腹痛缓解无复发,63.9％（23/36）的患者体重增加,生活质量改善。高淀粉酶血症、出血的发生率分别为13.9％（5/36）和5.6％（2/36）,均经一般内科治疗于3日内缓解。支架阻塞、支架脱落的发生率分别为12.5％（3/24）和4.2％（1/24）。结论 经内镜治疗胰管狭窄是安全而有效的方法。     

胆胰管良恶性梗阻的双支架联合引流

目的 探讨胆、胰管良恶性狭窄或梗阻时内镜双支架联合引流的操作技术及其临床疗效。方法 所有患者先行经内镜逆行胰胆管造影，了解胆、胰管狭窄或梗阻的部位、程度，并确定置入支架的外径及长度；然后胆、胰管分别置入导丝，并在导丝引导下按常规分别置入胆管和胰管引流支架。术后观察血清淀粉酶变化及黄疸、腹痛、腹泻等临床症状的改善情况。结果 14例胆、胰管并存狭窄或梗阻患者（壶腹癌5例、胰头癌4例、乳头部癌3例及胰头部慢性炎症2例）均一次操作成功，置入胆管塑料支架14根（12例1根，1例2根），置入金属支架1根；同时还置入胰管支架14根。术后2周、1个月及3个月黄疸消失率分别为50．0％、71．0％和93．0％，术后2周上腹痛缓解率为75．0％；7例腹泻患者，术后1个月5例症状消失，2例明显减轻。未发生与操作相关的早期并发症，术后3个月未发现支架移位及阻塞情况。结论 胆、胰管良恶性狭窄患者经内镜双支架联合引流是一种简便、安全、有效的治疗方法，既能解除黄疸，又能减压止痛，改善胰腺外分泌功能。