合并十二指肠乳头旁憩室内镜下逆行胆胰管造影的操作方法及技巧探讨

Operation methods and skills of ERCP combined with periampullary diverticula

目的探讨合并十二指肠乳头旁憩室内镜下逆行胆胰管造影(ERCP)的操作方法和技巧。方法回顾性分析2009年3月～2010年1月在该院与南医大二附院行ERCP且合并十二指肠乳头旁憩室的143例的临床资料。分析十二指肠乳头旁憩室对造影成功率及其并发症的影响。结果使用切开刀直接插管成功122例,成功率87.1%(122/140);采用双导丝技术插管8例,成功率100%(8/8);采用胰管支架置入辅助插管5例,成功率100%(5/5);针状刀预切开乳头插管5例,成功率80%(1/5),2例术中明显出血;采用小活检钳提拉乳头旁粘膜辅助插管2例,成功率100%(2/2);1例未找到十二指肠乳头,未行ERCP,总成功率为98.6%。胆总管结石患者91例(63.6%),化脓性胆管炎患者10例(7%),胆管癌患者6例(4.2%),胆总管及肝总管良性狭窄5例(3.5%),胆总管下段乳头口狭窄16例(11.1%),胆源性胰腺炎10例(7.0%),十二指肠乳头腺瘤2例(1.4%),慢性胰腺炎并胆管下段狭窄3例(2.1%)。结论合并乳头旁憩室ERCP应谨慎操作,根据乳头的特点采用不同的操作方法和技巧有助于临床提高ERCP插管的成功率,减少并发症。

【Objective】To study the operation methods and skills of ERCP combined with periampullary diver-ticula.【Methods】The clinical data of 143 patients received ERCP combined with JDP from March 2009 to January 2010 were retrospectively reviewed.The effects of PAD on the success rate of ERCP and complications were ana-lyzed.【Results】One hundred and forty patients successfully underwent therapeutic ERCP,the success rate was 98.6 %.ERCP was successful in 122 of 143 cases（87.1%） using standard sphincterotomy technique;The cases who could not undergo the standard sphincterotomy were treated by double-wire technique（8/8）,pancreatic stent inserted technique（5/5） or NKF（needle-knife fistulosphincterotomy） technique（4/5）.Of all the patients,91 were common duct stones,10 were acute suppurative cholangitis,6 were cholangiocarcinoma,5 were benign billiary strictures,16 were stricture of papilla.10 were acute pancreatitis,3 were chronic pancreatitis combined with billiary strictures.【Conclusions】ERCP combined with PAD should be carefully performed.It is helpful to increase the success rate of ERCP and decrease the complications according to the character of PAD using the different operation methods and skills.