内镜逆行胰胆管造影在胰管结石诊治中的临床价值

Clinical Value of Endoscopic Retrograde Cholangiopancreatography in the Diagnosis and Treat-ment of Pancreatic Ductal Stones

目的：探讨内镜逆行胰胆管造影（ＥＲＣＰ）在胰管结（ＰＤＳ）诊断与治疗中的价值。方法：回顾分析１９９８年１月～２０００年１２月本院经ＥＲＣＰ诊治的１８例ＰＤＳ患者的治疗方式和结果。结果：卫８例＊ＤＳ患者临床上均以上腹痛为主要首发症状且合并慢性胰腺炎，其中１例合并胰腺癌。经Ｂ超检查，１０例患者硷出有ＰＤＳ或胰管扩张；全部病例经ＥＲＣＰ检查后均明确显示有ＰＤＳ和胰管扩张。经ＥＲＣＰ＋乳头括约肌切开术（ＥＳＴ）／胰管括约肌切开术（ＥＰＳＴ）成功取石４例；行ＥＰＳＴ＋体外震波碎石（ＥＳＷＬ）及ＥＳＷＬ＋胰管内支架引流（ＥＲＰＤ）者各１例，半年后复查时胰石消失；行ＥＲＰＤ者１２例。３例患者置管后３个月内因伴主胰管多发、巨大结石或胰腺癌而接受手术治疗。１８例患者经１～１１个月的随访，腹痛近期（＜３个月）缓解率为８８．９％，远期（＞３个月）缓解率为７５刀％，体重、脂肪泻、胰腺内、外分泌功能不足表现有不同程度的改善。ＥＲＣＰ术后早期并发症主要为一过性高淀粉酶血症，支架阻塞是其晚期并发症。结论：ＥＲＣＰ能清晰显示结石的位置、大小、形态及数量，是诊断ＰＤＳ的主要手段。经ＥＲＣＰ取石具有安全可靠、创伤小、疗效满意及患者易于接受等优?

Background/Aims: To appraise the value of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and treatment of pancreatic ductal stones (PDS). Methods: 18 patients with PDS treated in our hospital by ERCP from Jan. 1998 to Dec. 2000 were analyzed retrospectively. Re- sults: Epigastric pain was the first symptom of PDS and all patients were associated with chronic pan- creatitis, one with pancreatic carcinoma. All patients underwent ultrasonography and ERCP, 10 cases were found to have PDS by ultrasonography and all of them by ERCP. PDS were extracted successfully in 4 patients by ERCP combined endoscopic sphincterotomy (EST)/endoscopic pancreatic sphincteroto- my (EPST). One patient accepted EPST and extracorporeal shock wave lithotripsy (ESWL), one under- went ESWL and endoscopic retrograde pancreatic drainage (ERPD), the PDS disappeared 6 months lat- er. Plastic stents were placed into pancreatic duct in 12 patients. 3 of 18 patients accepted operative treatment because of the presence of multiple, large ductal stones and pancreatic carcinoma. After 1~ 11 months follow-up, 88.9% of the patients had pain relief in three months, and the long-term remission rate was 75.0%. The pancreatic exocrine and endocrine function tests, the body weight and steatorrhea all improved. During the endoscopic treatment, there were no serious complications. The early com- plication was hyperamylasemia, while occlusion of the stent was a late complication. Conclusions: ERCP can clearly show the site, size, shape and number of PDS. It is not only a major technical meth- od for diagnosis of PDS, but also an important therapeutic procedure, with some advantages such as safe, minimal trauma and it is acceptable by the patients.