肝胆胰外科杂志2024，Vol.36Issue(8)：486-490,5.DOI:10.11952/j.issn.1007-1954.2024.08.009
内镜逆行胰胆管造影联合胆管支架治疗胆总管囊肿切除术后慢性胰腺炎
Effect of endoscopic retrograde cholangiopancreatography combined with biliary stent in the treatment of chronic pancreatitis after choledochal cyst resection
摘要
Abstract
Objective To evaluate the effect of endoscopic retrograde cholangiopancreatography(ERCP)combined with biliary stent in the treatment of chronic pancreatitis(CP)after choledochal cyst resection.Methods The clinical data of 35 CP patients after choledochal cyst resection,who treated with ERCP between Jan.2019 and Dec.2023 in Shanghai Pudong Hospital and Shanghai East Hospital,was retrospectively analyzed,and the treatment experience was summarized.Results Among the 35 CP patients,27 cases were diagnosed as high pancreaticobiliary maljunction(PBM)by ERCP,including 20 cases of common bile duct stump stones with bile duct sphincter stricture,5 cases of simple bile duct sphincter stricture,and 2 cases of pancreatic duct stricture;the remaining 8 cases were diagnosed as low PBM,including 5 cases of papillary sphincter stricture,2 cases of pancreatic sphincter stricture,and 1 case of pancreatic sphincter stricture with pancreatic duct stones.All patients were treated with ERCP,2 cases were stone free,8 patients were relieved of stricture.Among 27 patients with unresectable stricture,22 cases of stricture with fully covered metal stents(FCMS)and 5 cases of stricture with plastic stents.The postoperative abdominal pain relief rate was 100%(35/35),the incidence rate of acute pancreatitis was 5.7%(2/35),and the incidence rate of hyperamylasemia was 14.3%(5/35).After 3-7 months of indwelling,the stents were successfully removed in all 27 patients,the stricture relief rate was 92.6%(25/27),100%(22/22)for FCMS and 60%(3/5)for plastic stents;the stone clearance rate of 19 cases was 100%(19/19),in which the stone disappearance rate was 63.2%(12/19),and the stone dissolution rate was 100%(19/19).During the follow-up of 4-63 months,the recurrence rate of pancreatitis was 11.4%(4/35).After repeat ERCP treatment,pancreatic duct stricture was found in all patients,and pancreatic duct stents were replaced.Conculsion Stones and stricture are the main causes of CP after choledochal cyst resection.ERCP with FCMS can not only relieve the stricture,but also promote the dissolution and excretion of stones.关键词
内镜逆行胰胆管造影/胆总管囊肿切除术/慢性胰腺炎/全覆膜金属支架/胰管狭窄/胰管结石Key words
endoscopic retrograde cholangiopancreatography/choledochal cyst resection/chronic pancreatitis/fully covered metal stent/pancreatic duct stricture/pancreatic duct stones分类
医药卫生引用本文复制引用
王晓亮,张诚,张昊,何川琦,周志杰,杨玉龙..内镜逆行胰胆管造影联合胆管支架治疗胆总管囊肿切除术后慢性胰腺炎[J].肝胆胰外科杂志,2024,36(8):486-490,5.基金项目
上海市浦东新区卫生健康委员会人才培养计划(PWR12022-4). （PWR12022-4）
