超声内镜引导下胰管穿刺术联合经内镜逆行副胰管造影术治疗胰腺分裂症1例

1例慢性胰腺炎、胰管结石伴梗阻性黄疸患者, 因经内镜逆行胰胆管造影术主乳头胰管反复插管困难, 副乳头开口难辨, 最后选择在全麻下行超声内镜引导下胰管穿刺术联合经内镜逆行副胰管造影术+副乳头扩张术+胰管探条扩张术+胰管支架置入术, 术中补充诊断:胰腺分裂。本文报道了该疑难病例的内镜治疗过程及护理配合要点。     

胰管支架联合吲哚美辛栓对困难胆管插管术后胰腺炎的预防作用分析

目的探索胰管支架联合吲哚美辛栓直肠给药对内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography, ERCP)困难插管术后胰腺炎(post-ERCP pancreatitis, PEP)的预防作用。方法 2019年1月—2021年12月在南京医科大学附属杭州医院行ERCP治疗的胆道疾病患者术前30 min予吲哚美辛栓100 mg纳肛, 将术中发生困难胆管插管的患者(n=204)纳入本研究。根据随机数字数表将患者分为两组, 联合组术中置入胰管支架(n=104), 吲哚美辛组不置入支架(n=100)。比较两组术后高淀粉酶血症及PEP的发生率。结果联合组术后高淀粉酶血症[21.2%(22/104)比34.0%(34/100), χ2=4.22, P=0.040]及PEP发生率[14.4%(15/104)比32.0%(32/100), χ2=8.88, P=0.003]均明显低于吲哚美辛组, 但两组重症PEP发生率之间差异无统计学意义[1.0%(1/104)比1.0%(1/100), χ2=0.001, P=0.978]。结论与单用吲哚...     

内镜逆行胰胆管造影术困难胆管插管方式的研究进展

成功选择性胆管插管是进行内镜逆行胰胆管造影术的关键, 如何有效提高困难胆管插管成功率并降低术后胰腺炎发生率是目前医学讨论热点。本文总结不同内镜逆行胰胆管造影术插管方式, 为困难胆管插管方式选择提供参考。     

胰头部囊腺瘤局部切除术前内镜下置入胆胰管支架的安全性及疗效分析

为探讨内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography, ERCP)下胆胰管支架置入联合胰腺局部切除术(enucleation, En)治疗胰头部囊腺瘤的安全性与临床疗效, 回顾性分析2020年1月—2023年1月杭州市第一人民医院行ERCP+En(ERCP+En组, n=11)与En(En组, n=12)治疗的胰头部囊腺瘤患者临床资料, 对比两组一般情况、术中情况、围术期并发症、住院时间及随访结果。两组患者一般资料差异无统计学意义(P>0.05)。ERCP+En组中, ERCP置入胆胰管支架顺利, 术后出现高淀粉酶血症3例, 经保守治疗好转。两组En术中均无中转开腹、输血发生, 术后均无严重并发症。ERCP+En组与En组术后B/C级胰瘘分别为0例和3例(P=0.001), 中位住院时间分别为11 d和15 d, 差异有统计学意义(U=2.25, P=0.031);两组中位En时间(145 min比155 min, U=0.03, P=0.952)、中位术中出血量(100 mL比120 mL, U=0.05, P=...     

内镜逆行胰胆管造影术联合超声内镜引导下胰管支架引流治疗重症胰腺炎后胰管离断综合征1例

本文报道一例患者急性坏死性胰腺炎后出现胰瘘、胰管离断, 曾放置腹腔引流管引流胰腺远端胰液, 第1次ERCP造影证实胰腺体部胰管不完全断裂, 放置双猪尾胰管支架以引流胰腺远端胰液, 后胰管支架移位, 再次ERCP, 导丝及造影剂无法逆行越过胰体部胰管断裂处, 后通过超声内镜引导下胰管穿刺引流术经胃壁穿刺胰管, 内镜下放置7 Fr×150 mm塑料支架至胰管断裂处。患者术后恢复良好, 定期随访腹部CT提示胰管支架位置良好, 胰腺体尾部积液逐渐吸收。     

胰管断裂综合征的诊治

急性坏死性胰腺炎出现主胰管断裂使上游胰腺组织和十二指肠失去正常的解剖连续关系, 这种现象被称为胰管断裂综合征(DPDS)。断裂的胰管使持续分泌的胰液无法到达十二指肠, 导致胰周积液、胰腺外瘘、胰腺炎等, 处理难度大, 颇具挑战。     

胰十二指肠切除术后行内镜逆行胰胆管造影术诊治的回顾性分析

目的评估胰十二指肠切除术后行内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography, ERCP)的有效性和安全性及内镜选择策略。方法回顾性分析2013年1月—2021年12月在空军军医大学第一附属医院消化内镜中心接受ERCP诊治的34例胰十二指肠切除术后患者的临床资料, 分析插镜成功率、诊断成功率、治疗成功率、ERCP成功率和不良事件的发生情况。结果 34例患者接受了50例次ERCP诊治。胰十二指肠切除术后ERCP的插镜成功率、诊断成功率、治疗成功率和ERCP成功率分别为92.0%(46/50)、93.5%(43/46)、88.4%(38/43)和76.0%(38/50)。结肠镜和气囊辅助式小肠镜辅助ERCP的成功率分别为76.0%(19/25)和75.0%(18/24);共有3例不良事件, 1例患者术中发生胆肠吻合口黏膜撕裂, 1例患者术中发生心跳呼吸骤停, 1例患者术后发生胆管炎。结论胰十二指肠切除术后行ERCP总体是有效和安全的。胰十二指肠切除术后使用结肠镜和气囊辅助式小肠镜辅助ERCP具有相似的成功率。     

胆管内射频消融术治疗恶性胆管狭窄的研究进展

胆管内射频消融是新近用于胆管恶性肿瘤治疗的新方法, 本文就该技术近年来的研究进展做一探讨。     

慢性胰腺炎癌变风险临床研究进展

胰腺癌是一种预后极差的恶性肿瘤。慢性胰腺炎是胰腺癌的危险因素之一, 流行病学研究表明, 慢性胰腺炎患者中胰腺癌的发病率为0.68%～6.55%, 吸烟、年龄、遗传因素和代谢因素等是加速慢性胰腺炎进展为胰腺癌的重要原因。目前对于慢性胰腺炎癌变的筛查存有争议, 尚无有效筛查手段识别早期癌变。本文基于全球慢性胰腺炎癌变的临床研究文献, 对慢性胰腺炎向胰腺癌进展的风险因素及其筛查、监测指标进行综述。     

原发性硬化性胆管炎的内镜治疗及预后分析

目的探讨原发性硬化性胆管炎(primary sclerosing cholangitis, PSC)患者行经内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography, ERCP)的诊疗效果及预后相关因素。方法纳入2009年5月—2020年5月西京医院接诊的PSC病例。回顾性收集人口学、临床症状、实验室和影像学检查、ERCP诊疗等数据, 探讨ERCP治疗人群特点及临床疗效, 随访观察疾病进展、无移植生存期和总体生存期等。结果共纳入74例PSC患者, 中位年龄53岁, 男性占54.1%(40/74), 合并胆管显性狭窄、炎症性肠病和其他自身免疫性肝病患者分别占32.4%(24/74)、18.9%(14/74)和17.6%(13/74), 接受ERCP患者占36.5%(27/74)。Logistic回归分析显示, 高总胆红素(OR=12.33, 95%CI:1.24～122.63, P=0.032)和合并胆管显性狭窄(OR=24.67, 95%CI:3.40～178.88, P=0.002)是ERCP诊疗的独立危险因素。ERCP操作和...     

Patency of the accessory pancreatic duct in relation to its course and shape: a dye-injection endoscopic retrograde pancreatography study

Objective: The accessory pancreatic duct (APD) exhibits several appearances on pancreatography. We examined the patency of the APD by dye-injection endoscopic retrograde pancreatography (ERP), and studied the relationship between patency and duct course and shape.
Methods: There were 213 patients with satisfactory imaging of the entire normal APD who also underwent dye-injection ERP. The length and maximum diameter of the APD and the length of the main pancreatic duct (MPD) from its orifice to the junction with the APD were measured.
Results: The caliber of the patent APD was 1.6 ± 0.6 mm. This was significantly larger than the caliber (1.1 ± 0.4 mm) of the nonpatent APD (   p < 0.01  ). The length of the MPD from its orifice to the junction with the patent APD was 32.7 ± 12.5 mm. This was significantly longer than the length to the junction with the nonpatent APD (22.5 ± 8.1 mm) (   p < 0.01  ). The APD was classified according to duct course: long type, intermediate type, short type, or ansa type. Patency was most common in the long type APD (74.5%). The terminal shape of the APD was also used to classify the ducts: stick type, branch type, saccular type, cudgel type, or spindle type. Patency was most frequently observed in the spindle and cudgel type ducts.
Conclusions: Patency of the APD might be dependent on duct caliber, course, and terminal shape of the duct.     

Patency of the accessory pancreatic duct evaluated by dye‐injection endoscopic retrograde pancreatography: Methods and clinical implication

The accessory pancreatic duct (APD) is sometimes developmentally obliterated near the duodenum. We evaluated patency of the APD by dye‐injection endoscopic retrograde pancreatography (ERP). We injected 2–3 mL contrast medium containing indigocarmine into the main pancreatic duct (MPD) via a selectively cannulated endoscopic catheter. Patency of the APD was evaluated by observing the excretion of dye from the minor duodenal papilla. Of the 291 control cases studied, 43% demonstrated a patent APD. Patency of the APD in patients with acute pancreatitis was only 17%, signi?cantly lower than that of controls (P < 0.01). Mean caliber of patent APD was 1.6 ± 0.5 mm, signi?cantly greater than the 1.1 ± 0.5 mm of non‐patent APD (P < 0.01). Regarding the terminal shape of the APD, spindle‐ and cudgel‐type APD were frequently patent (93% and 88%, respectively, (P < 0.01). With respect to APD course, long‐type APD showed most frequent patency (75%, P < 0.01). Dye‐injection ERP represents a simple and de?nitive method for examining APD function. A patent APD may prevent acute pancreatitis by reducing pressure in the MPD. Patency of the APD might be dependent on duct caliber, course, and terminal shape.     

The role of endoscopic retrograde pancreatography in the treatment of traumatic pancreatic duct injury.

BACKGROUND: The status of the main pancreatic duct (MPD) is the most important determinant of the morbidity and mortality associated with pancreatic trauma. Early diagnosis and optimal treatment are critical, especially when there is MPD injury. METHODS: Twenty-three patients with pancreatic trauma were studied prospectively with respect to clinical and laboratory findings, CT, and endoscopic retrograde pancreatography (ERP). Treatment modalities and clinical outcome were assessed in relation to ERP findings. RESULTS: The pancreatic duct was injured in 14 of 23 patients (11 MPD, 3 branch duct). Contrast leakage from the MPD into peritoneal cavity at ERP confirmed MPD injury in 8 patients, who underwent surgical exploration. Three patients with leakage from a branch duct into the pancreatic parenchyma recovered with conservative treatment. Three patients in whom ERP demonstrated contrast leakage from the MPD confined to the parenchyma underwent successful transpapillary stent insertion with complete resolution of the leak at 3-month follow-up. Patients who underwent ERP more than 72 hours after trauma had a significantly higher rate of pancreas-associated complications and a tendency to remain hospitalized longer than patients who underwent ERP earlier. CONCLUSION: Early ERP is one of the most useful methods for demonstrating MPD injury. ERP assists with treatment planning based on the degree of pancreatic duct injury.     

Role of endoscopic retrograde pancreatography in pancreatic ascites

Summary We present a case of pancreatic ascites. The diagnosis was strongly suspected on the basis of ascitic fluid analysis and was confirmed by observation of pancreatic duct contrast leakage at endoscopic retrograde panreatography (ERP). Computed tomography was not helpful in this case. For localization and final confirmation of the lesion, ERP is the most valuable investigative method.     

Relationship between the shape and the patency of Santorini's accessory pancreatic duct revealed by a balloon endoscopic retrograde pancreatography compression study

Background: Pancreatic juice flows into the duodenum via two pancreatic ducts including Wirsung's duct (main pancreatic duct) and Santorini's duct (accessory pancreatic duct). In contrast to Wirsung's duct, the precise anatomy and functions of Santorini's duct are still obscure. Methods: We clinically examined the shape and the patency of Santorini's duct using a balloon endoscopic retrograde pancreatography compression study (balloon ERP‐CS) and analyzed 178 cases out of a total of 683 of balloon ERP‐CS cases according to our criteria. Results: We found the total patency ratio of Santorini's duct to be 78.1% (139 of 178 cases). The shape of Santorini's duct, as examined by balloon ERP‐CS, was classified into four types. The most common types were the Rod type (44%) and the Spindle type (25%). The Branch type comprised 22%. The most rare type was the Cystic type (9%). The Rod type and Spindle type showed a high patency ratio (more than 95%), but the Cystic type and Branch type showed lower levels (36 and 31%, respectively). Conclusions: Most cases with a poor flow of Santorini's duct were observed, especially in the Cystic and Branch types. In such cases, Santorini's duct could not function as a safety valve when a Wirsung's obstruction occurred in association with stones, tumors or edema in the papilla of Vater.     

Retroperitoneal perforation of a pancreatic cyst during endoscopic retrograde pancreatography

A 70‐year‐old man was admitted to Ueno Municipal Hospital, Ueno, Japan, for evaluation of abdominal distension. Computed tomography showed a 1 × 1 cm cyst at the pancreas tail. Endoscopic retrograde pancreatography (ERP) showed a normal pancreatic duct after the first gentle injection and an enhanced cyst at the pancreas tail. Extravasation of the contrast medium occurred from the pancreatic duct to the superior‐dorsal extrapancreas at the same time of the next low‐pressure manual injection. Computed tomography showed extravasation of the contrast medium from the pancreas cyst to the retroperitoneal space after ERP. It was considered that the cyst wall weakness, in addition to slight elevated pancreatic duct pressure, caused the disruption of the cyst wall.