ERCP在不明原因复发性胰腺炎诊治中的作用

Role of ERCP in the Diagnosis and Treatment of Unexplained Recurrent Pancreatitis

目的探讨内镜逆行胰胆管造影(ERCP)在不明原因复发性胰腺炎诊治中的作用。方法本院2005年1月～2011年6月26例不明原因复发性胰腺炎患者,其中男10例,女16例,年龄31～85岁,中位年龄49岁,病程1～3年,发病次数2～4次。全部病例在急性发作期或发作间期均行磁共振下胰胆管造影(MRCP)及ERCP。结果 26例患者行MRCP均未能明确诊断,经ERCP患者明确病因者12例(10例为胆管微结石,2例胰管开口狭窄并结石),可疑病因者14例(乳头旁憩室6例,十二指肠乳头炎8例)。并根据ERCP诊断结果24例行内镜下胆管乳头括约肌切开术(EST),2例行胰管乳头括约肌切开术。26例患者术后随访1～2年胰腺炎未再复发,ERCP和EST过程中无胰腺炎加重、出血及穿孔等严重并发症发生。结论 ERCP对不明原因复发性胰腺炎的临床诊断与治疗具有重要的作用。

Objective To investigate the role of endoscopic retrograde cholangiopancreatography（ERCP） in the diagnosis and treatment of unexplained recurrent pancreatitis.Method 26 cases of unknown cause in patients with recurrent pancreatitis in our hospital from January 2005 to June 2011 were included,of which 10 cases were male and 16 were females,age range 31 ~ 85 years old.Mean age of the patients was 49 years old,1 to 3 years duration.the number of incidence were 2 or 4 times.All patients accepted Magnetic resonance cholangiopancreatography（MRCP） and ERCP in the acute attack or attack interval.Results Of 26 patients,none have clear diagnosis after treated with MRCP,then 26 cases accepted ERCP,12 cases have clear cases（10 cases for bile duct micro-stones,2 cases of pancreatic opening duct stricture and stones）,14 cases have suspected causes（6 cases were diverticulum juxtapapillary,8 cases were duodenal inflammation）.And in accordance with the results of ERCP diagnosis,24 patients were treated with endoscopic sphincterotomy（EST）,2 patients were treated with pancreatic sphincterotomy.26 patients had no recurrence of pancreatitis after following up 1 to 2 years.Pancreatitis,bleeding and perforation and other serious complications did not happened in the process of ERCP and EST.Conclusion ERCP plays an important role in clinical diagnosis and treatment for unexplained recurrent pancreatitis.