内镜在胰胆管合流异常诊疗中的作用探讨

目的探讨ERCP在胰胆管合流异常中的诊断价值，评估内镜治疗的效果。方法16例胰胆管合流异常（PBM）患者，通过ERCP造影进行PBM分型，结合临床症状，分析引起相关疾病的机制、影像特点，根据合并的其它胰胆疾病，选择适当的内镜取石、扩张或引流等治疗，观察治疗效果。结果16例胰胆管合流异常患者多伴有腹痛、呕吐、黄疸等症状，及转氨酶和／或淀粉酶水平的升高。其中，Ⅰ型（B—P型）7例，Ⅱ型（P—B型）5例，Ⅲ型（复杂型）4例；合并胆总管囊肿扩张10例，无扩张者5例，胆管癌并狭窄1例；伴有胆管结石11例（4例为蛋白栓）、胰管结石2例（1例不伴胆管结石）。9例予内镜下胆管取石，2例胰管取石，术中置入胆道支架引流7例，行鼻胆管引流3例，胰管支架置入5例，胆道金属支架置人1例。术后临床症状均明显缓解。结论ERCP是一种可靠的诊断手段，其分型与PBM相关疾病表现有明显相关，选择性、暂时性的内镜治疗在外科术前是有效的、必要的。

Endoscopic diagnosis and treatment for pancreaticobiliary maljunction

Objective To explore the diagnostic value of ERCP and to evaluate the therapeutic effect of endoscopy. Methods Data of 16 patients with pancreaticobifiary maljunction （PBM） were ana-lyzed. After eholangiopancreatography, PBM sub-typing was performed on all patients. Considering clinical symptoms,we analyzed ERCP image characteristics and the mechanism of related diseases caused by PBM. According to patients＇ sub-types and related-pancreaticobiliary diseases, appropriate endoscopic method was selected as treatment before surgery such as stone extraction,expansion or stent drainage. Results Most pa-tients were accompanied by abdominal pain, vomit, jaundice, elevated serum transaminases and/or amylase levels. There were 7 type Ⅰ （B-P）, 5 type Ⅱ （P-B） and 4 type Ⅲ （complex） cases; 10 cases combined with choledochal dilation （cystic in 7 ;cylindrical in 3 ）, and 5 cases without; 1 case of bile duct cancer; 11 cases （4 protein plugs） of bile duct stones and 2 pancreatic duct stones （ not accompanied by bile duct stones in 1 ）. Nine patients underwent endoscopic bile duct stone extraction successfully, and 2 pancreatic duct stone extraction. Except for bile/pancreatic duct stone removal, other endoscopic treatment applied in pa-tients included biliary stent drainage in 7 cases, nasal biliary drainage in 3, self-expanding biliary metal stent placement in 1, and pancreatic stent placement in 5. All patients＇ clinical symptoms were significantly allevi-ated after endoscopic therapy. Conclusion ERCP is a reliable diagnostic procedure. The clinical manifesta-tions are closely related to sub-type of PBM. Temporary endoscopic therapy before surgery is considered to be effective and necessary.