内镜下胰胆分流术治疗隐匿性胰胆反流的临床分析

The clinical analysis of endoscopic pancreaticobiliary separation in the treatment of occult pancreaticobiliary reflux

目的探讨胆囊结石患者隐匿性胰胆反流(occult pancreaticobiliary reflux,OPBR)的病因及内镜下胰胆分流术(endoscopic pancreaticobiliary separation,EPBS)的疗效。方法回顾性分析2013年10月至2016年10月47例OPBR并胆囊结石患者的临床资料。结果47例患者平均胆汁淀粉酶(GBA)(864±575) U/L。40例行内镜逆行胰胆管造影,诊断为乳头炎26例,乳头旁憩室16例,乳头过长14例,乳头萎缩5例,壶腹内结石3例,乳头肿瘤2例。33例行EPBS,术后16例复查GBA,其中15例GBA恢复正常,GBA的差异有统计学意义[(1 161±764)U/L比(47±17) U/L(t=5.641,P<0.05)]。随访1~4年,未切除胆囊者中27例行EPBS无结石复发,9例未行EPBS者结石复发2例,结石复发率的差异有统计学意义(χ2= 21.340,P<0.05)。结论胰胆汇合部疾病是OPBR及胆囊结石形成的重要原因,EPBS能解除胰胆反流并降低胆道镜取石术后胆囊结石的复发率。

Objective To evaluate endoscopic pancreaticobiliary separation (EPBS) in patients with gallstone and occult pancreaticobiliary reflux (OPBR). Methods The clinical data of 47 cases with gallstone and OPBR from Oct 2013 to Oct 2016 was analyzed retrospectively. Results The mean gallbladder bile amylase (GBA) was (864±575) U/L.40 cases have undergone the treatment of endoscopic retrograde cholangiopancreatography.26 cases were diagnosed as duodenal papillitis,16 cases as periampullary diverticula,14 cases as long nipple,5 cases as atrophic papilla,3 cases as ampulla stone and 2 cases as papillary tumor.9 were diagnosed as pancreaticobiliary maljunction in the 14 patients with long nipple.33 cases were performed with EPBS.GBA was tested in 16 cases,and the GBA of 15 cases returned to normal level.The difference of GBA was statistically significant [(1 161±764) U/L vs.(47±17) U/L,t=5.641,P<0.05].Patients were followed up for 1 to 4 years,among 36 cases without cholecystectomy,there was no recurrence of cholecystolithiasis after EPBS in 27 cases,but 2 cases had recurrent gallstones in 9 cases without EPBS,and the difference of gallstone recurrence rate was statistically significant (χ2= 21.340,P<0.05). Conclusions Pancreaticobiliary junction diseases is an important cause for gallstone formation and OPBR.EPBS can avoid pancreaticobiliary reflux and reduce the recurrence rate of gallstone after choledochoscopic lithotomy.