ERCP在先天性胆总管囊肿的诊治作用

The Role of ERCP in the Diagnosis and Treatment of Congenital Choledochal Cysts

目的回顾性分析内镜下胰胆管造影术(ERCP)对先天性胆总管囊肿(CCC)的诊断作用,探讨其发病机制;初步总结内镜治疗原则并评价其在外科术前的效果。方法造影后辨别CCC的分型、与合并其他胰胆管疾病的关系;根据分型,选择乳头括约肌切开、取石、胆道引流等内镜治疗或外科手术。结果发现CCC 13例,包括Ⅰa型8例,Ⅰc型1例,Ⅲ型1例,Ⅳa型3例;合并胰胆管合流异常(PBM)10例,无合并PBM者3例。伴胆管结石9例(Ⅰa型5例,Ⅲ型1例,Ⅳa型3例),7例内镜下取石成功,取石后置入胆管支架引流4例,行鼻胆管引流2例;Ⅲ型者仅行乳头括约肌切开取石;2例因胆管狭窄扩张无效或结石过大,未予取石,仅置入胆管支架引流。合并胰管结石1例,取石后置入胰管支架。内镜治疗后临床症状均明显缓解。结论 CCC与PBM有密切的关联;根据合并症的具体情况,采取相应的内镜治疗措施,ERCP胆道取石和/或置管引流在外科术前是有效的、必要的。

Objective To retrospectively analyze the role of ERCP in the diagnosis of congenital choledochal cyst （CCC）;to discuss CCC pathogenesis, endoscopic treatment principles,and to evaluate its application before surgery. Methods The sub-type of congenital choledochal cysts were distinguished and their relationship with concurrent pancreaticobiliary diseases were defined by cholangiopancreatography; then appropriate endoscopic therapy methods, such as sphincterotomy,Stone removal,endoscopic biliary drainage or surgery were selected. Results Congenital choledochal cysts were diagnosed in 13 cases, including 8 cases with I a, 1 case with I c, 1 case with Ⅲ and 3 cases with IV a. Among them, there were 10 cases combined with pancreaticobiliary maljunction（PBM）. Bile duct stones were detected in 9 cases （ Ia in 5 cases, Ⅲ type in l,Ⅳ type in 3 cases） and were successfully removed in 7 cases with ERCP; then biliary stents were placed in 4 cases, nasal biliary drainage in 2 cases. Patients with Ⅲ type were treated with papilla sphincter to remove stone; only the hiliary stent for drainage was placed in 2 cases without stone removal because of bile duct structure expansion or big stone. One patient suffering with pancreatic duct stones was treated with pancreatic duct stent after stone removal. Thus all patients＇ clinical symptoms were significantly alleviated. Conclusion Congenital choledochal cysts closely relate with the PBM. Appropriate endoscopic treatments should be adopted based on actual complications, Biliary lithotomy and/or catheter drainage in preoperative surgery is considered to be effective and necessary.