慢性胰腺炎36例内镜治疗

36 CASES ENDOSCOPIC THERAPY IN CHRONIC PANCREATITIS

目的探讨慢性胰腺炎(CP)的内镜治疗方法及效果。方法回顾性分析2000年1月～2010年12月住院确诊为CP并行内镜治疗的患者36例,随访观察其临床疗效。结果采用内镜ERCP技术治疗36例CP患者,其中33例行EST/P;9例胰管明显狭窄行ERPD;2例副胰管扩张则行副乳头括约肌切开并行副胰管内支架置入;18例胰管结石先扩张,内支架置入再取石,其中7例取石困难:ERPD后再取石3例、ESWL后取石1例、中转手术3例;12例患者分别于术后第5、11个月出现支架阻塞予更换支架治疗。并发症发生率为9.1%(3/33),其中急性胰腺炎1例,感染1例,支架移位1例,无穿孔发生。术后腹痛、脂肪泻等症状完全缓解率、分别在1、6、12个月为75.86%、65.52%、68.97%,胰腺假性囊肿内支架引流3例,鼻胰管+内支架引流术4例。结论内镜治疗能有效缓解CP患者的腹痛症状,增加患者的体质量,是治疗CP的一种安全、微创、有效的手段。

Objective To investigate the endoscopic therapy of chronic pancreatitis （CP）and the effect. Methods Retrospective analysis the effect of 36 patients diagnosed CP and had received endoscopic treatment from January 2000 to December 2010. Results 33 cases received EST/P, 9 cases received ERPD due to pancreatic duct stenosis, 2 cases suffered dilatation of vice pancreatic duct received sphincterotomy and Vice pancreatic duct stent, 18 cases with pancreatic duct stones first received expansion and then removed the stone stent, 7 of those patients had problem with removing stones. 3 had the stone remove after ERPD, 1 had the stone remove after ESWL, Transit operation in 3 cases. 12 patients had to replase the stent due to blocks after the 5, or 11 -month of the first operation. Complication rate was 9.1% （3/33）, in which acute pancreatitis in 1 case, infection in 1 case, 1 case of stent migration. Relieve rates of abdominal pain, diarrhea and other symptoms in 1,6, 12 months Postoperative were 75.86%, 65.52%, 68.97%, Pancreatic pseudocyst drainage stent in 3 cases, nasal drainage duct ＋ stent drainage in 4 cases. Conclusion Endoscopic therapy can effectively relieve the symptoms of abdominal pain in patients with CP to increase the patient＇ s body mass, the treatment of CP is a safe, minimally invasive and effective means.