ERCP诊断和治疗十二指肠乳头癌39例

Endoscopic retrograde cholangiopancreatography for diagnosis and treatment of duodenal papillary carcinoma: Analysis of 39cases

目的:经内镜逆行性胰胆管造影(endoscopic retrograde cholangiogancretography,ERCP)诊断和治疗十二指肠乳头癌的应用价值分析.方法:39例十二指肠乳头癌患者均行ERCP并钳取病变组织行活组织病理检查,而后根据患者的病情及意愿分别采取不同的内镜治疗方法,包括金属支架置入引流(endoscopic metal biliary drainage,EMBD)、塑料支架置入引流(endoscopic retrograde biliary drainage,ERBD)、鼻胆管引流(endoscopic nose-biliary drainage,ENBD)等.结果:39例内镜检查考虑诊断为十二指肠乳头癌的患者均经病理学检查确诊,确诊率100%.39例患者中32例成功行内镜下胆道引流,成功率82.1%.其中行金属支架引流者7例,塑料支架引流者15例,鼻胆管引流者6例,支架联合鼻胆管引流者4例.胆管内放置引流1 wk后,患者腹痛、腹胀等不适症状较术前明显缓解,血清总胆红素、直接胆红素、碱性磷酸酶、谷氨酰转肽酶、谷氨酸转氨酶、天门冬氨酸氨基转移酶水平术后均明显降低,差异有统计学意义(P<0.05).结论:ERCP是诊断和姑息性治疗十二指肠乳头癌的重要手段之一.

AIM： To assess the value of endoscopic retrograde cholangiopancreatography （ERCP） in the diagnosis and treatment of duodenal papillary carcinoma.METHODS： Thirty-nine patients with duodenal papillary carcinoma underwent ERCP and histopathologic examination. After that, different endoscopic treatments were taken according to the patients＇ condition and their wishes, which included endoscopic metal biliary drainage （EMBD）, endoscopic retrograde biliary drainage （ERBD）, endoscopic naso-biliary drainage （ENBD） and so on. RESULTS： All the 39 patients who were considered to have duodenal papillary carcinoma by endoscopic examination were precisely diagnosed with the disease by histopathologic examination, and the rate of accurate diagnosis was 100%. With a success rate of 82.1%, 32 patients accepted endoscopic biliary drainage （EBD） successfully, of whom 7 received EMBD, 15 adopted ERBD, 6 underwent ENBD, and the left 4 were treated by both ENBD and EMBD/ERBD. 1 wk after EBD, the discomforts such as abdominal pain and distension were evidently relieved compared with the condition before operation. The levels of serum total bilirubin （STB）, direct bilirubin （DB）, alkaline phosphatase （ALP）, aspartate aminotransferase （AST）, glutamyltranspetidase （GGT）, and alanine aminotransferase （ALT） were significantly decreased compared with the values before EBD （P 〈 0.05）. CONCLUSION： ERCP is an effective method for the diagnosis and palliative treatment of duodenal papillary carcinoma.