良性胆系疾病行逆行胆胰管造影并发胰腺炎的相关危险因素

目的探讨良性胆系疾病行胆系疾病逆行胆胰管造影(ERCP)并发胰腺炎(PEP)的相关危险因素。方法选取2010年3月至2013年10月该院接受ERCP的患者200例,采用Pearson单因素分析及Logistic回归分析确定良性胆系疾病行ERCP并发PEP的相关危险因素。结果采用Pearson单因素分析显示,患者出现ERCP并发PEP与性别、年龄、十二指肠乳头旁憩室、乳头括约肌预切开、球囊扩张没有显著相关性(P>0.05),而与胆总管直径大小、Oddis括约肌运动功能障碍(SOD)、多次胰管插管、使用糖皮质激素以及有胰腺炎病史有关(P<0.05)。患者胆总管直径<10 mm、有SOD、多次胰管插管、使用糖皮质激素以及有胰腺炎病史是良性胆系疾病行ERCP并发PEP的危险因素(P<0.05)。结论正确认识良性胆系疾病行ERCP并发胰腺炎的相关危险因素并进行有效预防,可以降低PEP及其并发症的发生。     

细胞凋亡对急性胰腺炎发展和转归的影响

细胞凋亡，又称为细胞的程序性死亡（ＰＣＤ）。近年来发现胰腺腺体细胞的凋亡对急性胰腺炎严重度和转归有很大影响，为此，本文拟从这一新的视角探索急性胰腺炎的治疗。１胰腺腺体细胞的凋亡过去一直认为急性胰腺炎中细胞的死亡形式是坏死。近两年发现急性胰腺炎与腺体细...     

胰腺癌的内镜逆行胰胆管造影诊断

应用内镜逆行胰胆管造影(ERCP)诊断胆胰管疾病已有30多年的历史，造影成功率可达85％～95％．已成为诊断胆胰管结石、胆管良恶性狭窄和畸形、胆囊和胆囊管病变等胆胰管疾病和鉴别诊断疑难性腹痛的重要手段之一。ERCP对梗阻性黄疸、十二指肠乳头肿瘤和胰管异常的鉴别诊断尤为有利,检查中收集的胆汁和胰液还可作细菌培养和细胞学检查。磁共振胰胆管造影(MRCP)为无创伤性检查，诊断较为准确，有可能取代诊断性ERCP，但并不能取代ERCP在治疗方面的作用。     

内镜联合药物治疗急性重症胰腺炎153例临床分析

目的探讨内镜介入治疗急性重症胰腺炎(SAP)的临床价值。方法2001年2月至2006年2月将四川大学华西医院收治的SAP患者289例,随机分为对照组(136例)和内镜治疗组(153例)。对照组采用内科药物治疗;内镜治疗组在与对照组相同治疗的基础上行十二指肠乳头括约肌切开(EST)、取石、鼻胆管引流(ENBD)或鼻胰管引流术(ENPD)。比较两组患者腹痛、腹胀缓解时间,血清淀粉酶恢复正常时间,入院3d和6d的APACHEⅡ评分指标,平均住院天数、住院费用等。结果内镜治疗组腹痛、腹胀缓解所需天数[(10.5±3.0)d]明显低于对照组[(12.4±6.8)d,P<0.05]。与对照组相比,内镜治疗组血清淀粉酶恢复正常水平所需时间较短(P<0.05),APACHEⅡ评分值也较对照组下降快,平均住院日和治疗总费用均显著低于对照组(P均<0.05)。结论无论是胆源性SAP还是非胆源性SAP,在常规药物治疗的基础上,于起病后72h内实施EST ENBD或ENPD,可获得更好的治疗效果。     

磁共振胆胰管造影联用动态增强对胆管癌的诊断价值

目的：评价屏气磁共振胆胰管造影(MRCP)及联合应用动态增强MRI对胆管癌的临床诊断价值。方法：回顾性分析88例经手术、病理证实的胆管癌的MRCP及动态增强MRI表现。结果：88例检查均一次成功，全部病例胆胰管显示满意。MRCP对肝门型胆管癌和肝外胆管型胆管癌的定位诊断准确率均为l00％，定性诊断准确率为100％和52．2％，结合动态增强MRI扫描，对肝外胆管型胆管癌定性诊断准确率提高到91．3％。结论：MRCP检查成功率高，对肝门型胆管癌和肝外胆管型胆管癌定位准确，结合动态增强MRI扫描，定性诊断也有较高准确性。     

诊断与治疗性逆行胰胆管造影并发胰腺炎危险因素分析

目的：探讨诊断性胰、胆管显影与胆道支架、乳头括约肌切开取石术等治疗抗逆行胰、胆管造影（ERCP）,对术后并发胰腺炎的影响。方法：412例ERCP操作分为7组,诊断性ERCP为胆胰双管显影（ERCP）组、单纯胆管显影（ERC）组组与单纯管显影（ERP）组,治疗组ERCP分为双管显影加支架术（ERCP＋支架）组、ERC＋支架组、ERCP＋乳头肌切开（EST）取石组及ERC＋EST取石组,比较各组术后4h、24h血清淀粉酶及临床症状改变。结果：术后4h、24h高淀粉酶血症发生率为17．7％及4．4％,并发急性胰腺炎的发生率为3．95,各组中以ERP组发病率为最高。结论：在ERCP操作中,反复胰管造影是并发术后胰腺炎主要危险因素,EST、支架治疗并不增加胰腺炎的发病率。     

EUS联合ERCP在梗阻型轻症急性胆源性胰腺炎中应用及对细胞因子和淀粉酶的影响

目的观察超声内镜(EUS)联合十二指肠镜逆行性胆胰管造影(ERCP)对梗阻型轻症急性胆源性胰腺炎患者的治疗效果及对细胞因子、淀粉酶的影响。方法梗阻型轻症急性胆源性胰腺炎患者90例,随机分为对照组(n=45)和观察组(n=45)。对照组采用开腹手术治疗,观察组采用EUS联合ERCP治疗。观察两组治疗前、后肿瘤坏死因子(TNF)-α、白细胞介素(IL)-2、白细胞IL-6、IL-8、IL-10及淀粉酶水平变化。结果观察组治疗后腹痛缓解时间、尿淀粉酶恢复正常时间、血淀粉酶恢复正常时间及住院时间、显著短于对照组(P<0.05);观察组治疗后TNF-α、IL-2、IL-6及IL-8水平低于对照组(P<0.05);观察组术后并发症发生率(8.89%),显著低于对照组(20.00%,P<0.05)。结论梗阻型轻症急性胆源性胰腺炎患者采用EUS联合ERCP治疗效果理想。     

经内镜逆行胆胰管造影穿孔致后腹膜腔感染的介入治疗

乳头旁穿孔是少见的经内镜逆行胆胰管造影（ERCP）近期严重并发症，少量的渗漏保守治疗多能自愈，若有多量的肠液和胆汁、胰液进入后腹膜腔继发感染时，会引发败血症等甚至危及生命。穿孔后是否应手术，很难做出准确判断。笔者选择了非手术方法治疗2例，现结合文献，讨论如下。     

胰管反流与急性胆源性胰腺炎

急性胆源性胰腺炎 (ＡＧＰ)是一种常见的疾病 ,死亡率达10 %～ 15 % [1] 。其发作可能与胰管反流有关。为此 ,我们研究ＡＧＰ与胰管反流之间的关系 ,以证实胰管反流是诱发ＡＧＰ的可能因素。资料与方法一、一般资料1994年 1月～ 1998年 12月间 16 3例胆囊结石病患者 ,曾行胆道手术 (包括胆囊切除或胆总管引流 )。其中男 48例 ,女 115例 ,年龄为 2 5～ 74岁 (平均 5 6岁 )。二、方法有ＡＧＰ(Ｂ超或ＣＴ证实 )病史者 14例 ,无ＡＧＰ病史的149例作为对照。所有患者术中经胆囊管或Ｔ管作胆总管造影。造影剂为 30 %胆影葡胺 ,当胆总管注入 10ｍ…     

内镜逆行胰胆管造影术在急性胰腺炎早期治疗中的应用

急性胰腺炎以往认为是内镜逆行胰胆管造影（ ERCP）的禁忌证,但近年来由于 ERCP诊疗技术的不断发展和对急性胰腺炎病因的认识,文献报道对急性胰腺炎行早期 ERCP及其相关治疗,取得了较好的疗效,我科自 1995年 4月至 1999年 4月对 42例急性胰腺炎、复发性胰腺炎及慢性胰腺炎发作期患者行早期 ERCP及其相关治疗,并与对照组作对比观察,现总结报告如下。 　　资料与方法 　　1.临床资料：本组 89例患者均为我院收治并符合急性胰腺炎、复发性胰腺炎、慢性胰腺炎发作期诊断标准。早期 ERCP及其相关治疗组（简称治疗组） 42例,其中男…     

ERCP in acute biliary pancreatitis

The role of urgent endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis is for many years a subject for disagreement among physicians. Although the evidence seemed to be in favor of performing ERCP, endoscopists usually hesitate to conform to the guidelines. ERCP is an invasive procedure, with complications which can affect patients' outcome. Recent evidence suggests that we should probably modify our policy, recruiting less invasive procedures, like magnetic resonance cholangiopancreatography and endoscopic ultrasound, before conducting ERCP in patients with acute biliary pancreatitis. In this editorial the different aspects regarding the role of ERCP in acute biliary pancreatitis are discussed.     

经内镜逆行胰胆管造影术后并发急性胰腺炎的相关危险因素分析

目的分析经内镜逆行胰胆管造影(ERCP)并发急性胰腺炎的相关危险因素,以提高ERCP诊断及治疗水平,减少其发生率。方法回顾性分析了2003年6月至2007年7月于中国医科大学附属第一医院行诊断与治疗性ERCP的346例患者共399例次的临床资料。将患者按ERCP操作分为8组,比较各组术后24h血清淀粉酶及临床症状改变。结果399例次ERCP术后高淀粉酶血症发生率为12.5%(50/399),急性胰腺炎发生率为1.5%(6/399)。各组中高淀粉酶血症与急性胰腺炎发生率最高均为ERCP 胆管内支架组(分别为38.9%、11.1%)。399例次ERCP中,于2003年6月至2005年6月间进行153例次与2005年7月至2007年7月间进行的246例次比较,ERCP术后急性胰腺炎发生率分别为3.3%(5/153)、0.4%(1/246),差异有显著性意义。结论在ERCP操作中,胰管显影及术者经验是并发术后急性胰腺炎主要危险因素。     

ERCP联合胆道微结石检测对明确特发性急性胰腺炎病因的价值

目的:探讨内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)联合胆道微结石检测对特发性急性胰腺炎(idiopathic pancreatitis,IAP)病因的诊断价值.方法:以2008-01/2011-01急性胰腺炎(acute pancreatitis,AP)患者105例为研究对象,选择影像学(CT、B超、MRCP)检查后不能明确病因的特发性急性胰腺炎患者42例进行诊断性ERCP检查,同时收集胆汁5mL行胆道微结石监测.以2005-01/2008-01AP患者90例为对照组,应用SPSS13.0统计软件统计,取P<0.05差异有统计学意义.结果:对照组对AP病因确诊率为55.5%(50/90),联合检查组对AP的病因确诊率为87.5%(93/105),差异有统计学意义(P<0.05),ERCP联合胆道微结石检测对IAP病因有较高的确诊率.结论:ERCP联合胆道微结石检测对明确IAP病因有重要价值.     

细胞因子与内镜逆行胰胆管造影术后胰腺炎关系的研究进展

内镜逆行胰胆管造影术(enoscopiC retrograde cholangiopancreatography,ERCP)是当前诊治肝、胆、胰疾病的重要手段之一.急性胰腺炎是ERCP术后最常见、最严重的并发症,目前其发病机制仍未完全阐明.近年来研究的普遍共识是炎性细胞因子在轻症胰腺炎向重症胰腺炎演进过程中发挥了重要作...     

儿童胰腺炎ERCP术后并发症研究

目的 分析儿童胰腺炎患者经内镜逆行胰胆管造影(endoscopic retrograde cholangiop-ancreatography,ERCP)术后高淀粉酶血症、胰腺炎及出血等并发症的发生率,探讨其安全性。方法 回顾分析1997年2月～2002年2月间入住我科确诊为儿童胰腺炎并行ERCP术的27例患者的临床资料,其中急性胰腺炎(acute pancreatitis,AP)14例,慢性胰腺炎(chronic pancreatitis,CP)13例;诊断性ERCP 9例,治疗性ERCP18例。结果 27例患者ERCP术后总体并发症发生率为51.85％(l4/27),其中,高淀粉酶血症发生率22.22％(6/27),术后4、24h血清淀粉酶水平分别为(410.75±230.31)U/L、(367.25±233.90)U/L,48～72h后均恢复正常;胰腺炎发生率22.22％(6/27),均为轻型胰腺炎;乳头切开处出血、黑便发生率7.41％(2/27),均发生于胆总管结石行十二指肠乳头括约肌切开(endoscopicsphincterotomy,EST)+取石术后;诊断性ERCP组并发症的发生率低于治疗性ERCP组,但无统计学意义。结论 儿童胰腺炎患者ERCP术后具有较高的并发症发生率,内镜医师于ERCP术中应高度重视,采取必要的预防措施以减少并发症的发生。     

ERCP in acute pancreatitis

BACKGROUND: The role of endoscopic retrograde cholangiopancreatography (ERCP) in the management of acute pancreatitis has evolved over years since its introduction in 1968. Its importance in diagnosing the etiology of pancreatitis has steadily declined with the advent of less invasive diagnostic tools. The therapeutic implications of ERCP in acute pancreatitis are many fold and are directed towards management of known etiological factors or its related complications. This article highlights the current status of ERCP in acute pancreatitis. DATA SOURCES: An English literature search using PubMed database was conducted on ERCP in acute pancreatitis, the etiologies and complications of pancreatitis amenable to endotherapy and other related subjects, which were reviewed. RESULTS: ERCP serves as a primary therapeutic modality for management of biliary pancreatitis in specific situations, pancreatitis due to microlithiasis, specific types of sphincter of Oddi dysfunction, pancreas divisum, ascariasis and malignancy. In recurrent acute pancreatitis and smoldering pancreatitis it has a definite therapeutic utility. Complications of acute pancreatitis including pancreatic-duct disruptions or leaks, benign pancreatic-fluid collections and pancreatic necrosis can be beneficially dealt with. Intraductal ultrasound and pancreatoscopy during ERCP are useful in detecting pancreatic malignancy. CONCLUSIONS: The role of ERCP in acute pancreatitis is predominantly therapeutic and occasionally diagnostic. Its role in the management continues to evolve and advanced invasive procedures should be undertaken only in centers dedicated to pancreatic care.     

Endoscopic sphincterotomy in acute biliary pancreatitis: A question of anesthesiological risk

Two consecutive surveys of acute pancreatitis in Italy, based on more than 1000 patients with acute pancreatitis, reported that the etiology of the disease indicates biliary origin in about 60% of the cases. The United Kingdom guidelines report that severe gallstone pancreatitis in the presence of increasingly deranged liver function tests and signs of cholangitis (fever, rigors, and positive blood cultures) requires an immediate and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). These guidelines also recommend that patients with gallstone pancreatitis should undergo prompt cholecystectomy, possibly during the same hospitalization. However, a certain percentage of patients are unfit for cholecystectomy because advanced age and presence of comorbidity. We evaluated the early and long-term results of endoscopic intervention in relation to the anesthesiological risk for 87 patients with acute biliary pancreatitis. All patients underwent ERCP and were evaluated according to the American Society of Anesthesiology (ASA) criteria immediately before the operative procedure. The severity of acute pancreatitis was positively related to the anesthesiological grade. There was no significant relationship between the frequency of biliopancreatic complications during the follow-up and the ASA grade. The frequency of cholecystectomy was inversely related to the ASA grade and multivariate analysis showed that the ASA grade and age were significantly related to survival. Finally, endoscopic treatment also appeared to be safe and effective in patients at high anesthesiological risk with acute pancreatitis. These results further support the hypothesis that endoscopic sphincterotomy might be considered a definitive treatment for patients with acute biliary pancreatitis and an elevated ASA grade.     

应用EST技术治疗急性胆源性胰腺炎的临床体会

目的 探讨内镜下乳头Oddi括约肌切开术(endoscopic sphincterotomy,EST)在急性肌源性胰腺炎(acute gallstone pancreatitis,AGP)诊治中的应用价值。方法 将入选的189例AGP患者随机分为EST治疗组(n=79)和对照组(n=110),并根据APACHE Ⅱ评分,将每组再进一步分为重症组和轻症组,两组患者均给予中西医结合治疗。EST治疗组在入院后24h内行内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)+EST,如发现胆总管或胆胰共同通道有结石,则行网篮、气囊取石或碎石器碎石后取石,如结石多、结石直径大或取石未净,则EST术后再行鼻胆管引流术(endoscopic nasobilliary drainage,ENBD)。结果 对重症AGP,EST治疗组的并发症发生率转开腹手术率、住院天数及住院费用均明显低于对照组(P<0.05);而轻症AGP,两组之间无显著差异结论 早期应用EST技术治疗重症AGP是有效的和安全的。     

Factors and outcomes associated with pancreatic duct disruption in patients with acute necrotizing pancreatitis

Background and aimsAcute necrotizing pancreatitis (ANP) can affect main pancreatic duct (MPD) as well as parenchyma. However, the incidence and outcomes of MPD disruption has not been well studied in the setting of ANP.MethodsThis retrospective study investigated 84 of 465 patients with ANP who underwent magnetic resonance cholangiopancreatography and/or endoscopic retrograde cholangiopancreatography. The MPD disruption group was subclassified into complete and partial disruption.ResultsMPD disruption was documented in 38% (32/84) of the ANP patients. Extensive necrosis, enlarging/refractory pancreatic fluid collections (PFCs), persistence of amylase-rich output from percutaneous drainage, and amylase-rich ascites/pleural effusion were more frequently associated with MPD disruption. Hospital stay was prolonged (mean 55 vs. 29 days) and recurrence of PFCs (41% vs. 14%) was more frequent in the MPD disruption group, although mortality did not differ between ANP patients with and without MPD disruption. Subgroup analysis between complete disruption (n = 14) and partial disruption (n = 18) revealed a more frequent association of extensive necrosis and full-thickness glandular necrosis with complete disruption. The success rate of endoscopic transpapillary pancreatic stenting across the stricture site was lower in complete disruption (20% vs. 92%). Patients with complete MPD disruption also showed a high rate of PFC recurrence (71% vs. 17%) and required surgery more often (43% vs. 6%).ConclusionsMPD disruption is not uncommon in patients with ANP with clinical suspicion on ductal disruption. Associated MPD disruption may influence morbidity, but not mortality of patients with ANP. Complete MPD disruption is often treated by surgery, whereas partial MPD disruption can be managed successfully with endoscopic transpapillary stenting and/or transmural drainage. Further prospective studies are needed to study these items.     

口服硫酸镁对ERCP术后胰腺炎发生和血淀粉酶水平的影响

目的:探讨口服硫酸镁对预防经内镜逆行胰胆管造影术(encoscopic retrograde cholangio-pancreatography,ERCP)后胰腺炎发生和血淀粉酶水平的影响.方法:将120例拟行ERCP的胆总管结石患者随机分为观察组和对照组各60例,观察组ERCP前30min口服50%硫酸镁100mL,对照组不予硫酸镁,观察两组术前及术后3、24h血清淀粉酶水平及术后高淀粉酶血症和胰腺炎发生情况.结果:两组患者术前血清淀粉酶水平的差异无统计学意义(P>0.05),观察组术后3、24h血清淀粉酶水平均显著低于对照组3、24h血清淀粉酶水平(P<0.05).观察组ERCP术后的高淀粉酶血症和胰腺炎发生率均分别显著低于对照组(P<0.05).结论:口服硫酸镁在一定程度上可降低ERCP术后血清淀粉酶水平,对预防ERCP术后高淀粉酶血症及胰腺炎可能有一定积极作用,当需大样本证实.