ERCP在胆胰合流异常患者诊治中的应用

doi:10.3877/cma.j.issn.2095-3232.2024.05.019

目的

探讨ERCP治疗胆胰合流异常（PBM）的有效性及安全性。

方法

回顾性分析2018年1月至2022年12月在上海中医药大学附属曙光医院行ERCP诊治的83例PBM患者临床资料。其中男39例，女44例；平均年龄（30±16）岁。患者均签署知情同意书，符合医学伦理学规定。观察患者的临床表现、PBM分型、ERCP治疗情况、ERCP临床疗效及并发症情况。

结果

同期行ERCP患者4 769例，PBM检出率1.74%（83/4 769）。ERCP术中明确PBM分型Ⅰ型胆管汇入胰管型（B-P）39例（47%）；Ⅱ型胰管汇入胆管型（P-B）27例（33%）；Ⅲ型复杂型17例（20%）；PBM同时合并胰腺分裂症25例（30%）。83例患者行ERCP治疗175例次，插管成功率98.9%（173/175）。其中26例为单次，其余57例行2～5次。79例患者术后腹痛症状缓解；15例梗阻性黄疸患者术后TB、ALT、AST、GGT较术前明显下降；11例发热患者术后WBC、中性粒细胞百分比、降钙素原较术前明显下降。13例次发生术后并发症，8例次为高淀粉酶血症，2例次为术后胰腺炎，2例次为术后出血，1例次为ERCP术后胆囊炎。患者平均住院时间为（5.8±2.3）d。

结论

ERCP治疗PBM有效性高、并发症少，且可控性强，临床诊疗相对安全，相比传统的外科手术具有创伤小、可重复性好、患者住院天数少等优点，可作为PBM患者治疗的首选。

关键词: 胰胆管造影术，内窥镜逆行, 胆胰合流异常, 胰腺分裂症

Objective

To evaluate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of pancreaticobiliary maljunction (PBM).

Methods

Clinical data of 83 PBM patients who underwent ERCP in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from January 2018 to December 2022 were retrospectively analyzed. Among them, 39 patients were male and 44 female, aged (30±16) years on average. The informed consents of all patients were obtained and the local ethical committee approval was received. Clinical manifestations, PBM classification, procedures, clinical efficacy and complications of ERCP were observed.

Results

Among 4 769 patients undergoing ERCP, the detection rate of PBM was 1.74%(83/4 769). During ERCP, 39 cases (47%) were diagnosed with type Ⅰ biliary-pancreatic (B-P) maljunction, 27 cases (33%) of type Ⅱ pancreatic-biliary (P-B) maljunction, 17 cases (20%) of type Ⅲ complicated maljunction.25 cases (30%) of PBM were complicated with pancreatic divisum. 83 patients were treated with ERCP for175 times, and the success rate of intubation was 98.9%(173/175). Among them, 26 cases underwent ERCP once, and the remaining 57 cases received ERCP for 2-5 times. The symptoms of abdominal pain were relieved in 79 patients after surgery. Postoperatively, TB, ALT, AST and GGT levels were significantly decreased in 15 patients with obstructive jaundice. Postoperatively, WBC, neutrophil percentage and procalcitonin level were significantly declined in 11 patients with fever. Postoperative complications occurred in 13 case-times, including hyperamylasemia in 8 case-times, postoperative pancreatitis in2 case-times, postoperative bleeding in 2 case-times and cholecystitis after ERCP in 1 case-time, respectively. The average length of hospital stay was (5.8±2.3) d.

Conclusions

For the treatment of PBM, ERCP possesses high efficacy, mild complications, high controllability and safety in clinical diagnosis and treatment. Compared with traditional surgery, ERCP has multiple advantages of less trauma, higher repeatability and shorter length of hospital stay, which can serve as the optimal treatment for PBM patients.

Key words: Cholangiopancreatography, endoscopic retrograde (ERCP), Pancreaticobiliary mal-junction (PBM), Pancreas divisum

图1 ERCP诊治胆胰合流异常注：a为胆胰合流异常B-P型，示胆管汇入胰管；b为副乳头插管，示胰头区扩张的分支胰管；c为胆胰合流异常P-B型，示胰管汇入胆管；d为胆胰合流异常B-P型行胆总管扩张；e为副乳头扩张取石；f为副乳头双内镜下胰管支架内引流术

表1 PBM患者ERCP治疗前后疼痛评分、肝功能、血常规变化情况（

±s）

时间	NRS（分）	TB（μmol/L）	ALT（U/L）	AST（U/L）	GGT（U/L）	WBC（×10⁹/L）	中性粒细胞百分比（%）	降钙素原（ng/ml）
治疗前	7.7±1.8	77±13	325±98	331±94	319±107	9.6±3.7	82±9	0.11±0.02
治疗后	2.8±1.5	37±11	200±61	200±59	201±61	7.5±2.2	71±3	0.08±0.01
t值	18.441	20.765	10.124	10.504	8.588	4.414	9.759	12.582
P值	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

表1 PBM患者ERCP治疗前后疼痛评分、肝功能、血常规变化情况（

±s）

时间	NRS（分）	TB（μmol/L）	ALT（U/L）	AST（U/L）	GGT（U/L）	WBC（×10⁹/L）	中性粒细胞百分比（%）	降钙素原（ng/ml）
治疗前	7.7±1.8	77±13	325±98	331±94	319±107	9.6±3.7	82±9	0.11±0.02
治疗后	2.8±1.5	37±11	200±61	200±59	201±61	7.5±2.2	71±3	0.08±0.01
t值	18.441	20.765	10.124	10.504	8.588	4.414	9.759	12.582
P值	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

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Application of ERCP in diagnosis and treatment of patients with pancreaticobiliary maljunction

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Application of ERCP in diagnosis and treatment of patients with pancreaticobiliary maljunction