内镜下胰胆管逆行造影术在胆胰管导管内乳头状黏液性瘤中的应用价值

Diagnosis and treatment value of endoscopic retrograde cholangiopancreatography for intraductal papillary mucinous neoplasms of biliary and pancreatic ducts

目的探讨内镜下胰胆管逆行造影术(ERCP)对胆胰管导管内乳头状黏液瘤(IPMN)的诊治作用。方法回顾性分析经ERCP诊治的9例IPMN,分析临床表现、实验室检查、影像学表现等方面特点,经ERCP结合超声内镜作出初步诊断,采用超细内镜进入囊腔活检,以求术后病理确诊,后根据具体病情予相应内镜处理。结果 5例胆管导管内乳头状黏液瘤(IPMNs-B),4例胰管导管内乳头状黏液瘤(IPMNs-P),均无特异性的临床表现和实验室检查;超声、CT、MRI主要表现为胆胰管扩张,仅1例IPMNs-P胰头部见囊实性团块、壁结节及主胰管明显扩张(5.5 cm);ERCP均显示乳头开口扩张,胶冻样黏液流出,胰胆管不同程度扩张。9例行ERCP抽吸黏液后,1例IPMNs-B同时置入胆管及胰管支架,3例IPMNs-P置入胰管支架,1例放置胆道金属支架;术后1例出现轻症胰腺炎(11.1%,1/9),3例出现淀粉酶升高而无症状(33.3%,3/9),无出血或穿孔等并发症发生。结论ERCP是一种安全可靠的诊断方法选择,对IPMN的诊治具有重要作用。结合病理诊断,可为外科术前提供明确的诊断和可靠的证据。

【Objective】To study the role of ERCP in the diagnosis and treatment of intraductal papillary mucinous neoplasms of the biliary and pancreatic ducts（IPMNs-B, IPMNs-P）.【Methods】We retrospectively analyzed the clinical data of 9 patients treated by ERCP, including clinical symptoms, laboratory tests and imaging examination. We made the preliminary diagnosis with ERCP and endoscopic ultrasonography, or the ultrathin electronic gastroscope was put into cystic cavity for biopsy for pathological diagnosis. Then every case received appropriate endoscopic therapy according to the specific condition.【Results】9 cases of IPMN had no specific clinical symptoms and laboratory tests. The main performance of them were bile duct and pancreatic duct dilatation in ultrasound, CT and MRI examination, the cystic and solid mass was seen in only one case of IPMNs-P in the pancreatic head, mural nodules and dilated main pancreatic duct（5.5 cm）. ERCP suggested the opening of papilla expansion, jelly-like mucus outflow, and different degrees of bile and pancreatic duct dilatation. All cases cleaned the mucus, one case of IPMNs-B was inserted bile and pancreatic duct stent, 3 cases of IPMNs-P were inserted pancreatic duct stent and one case was inserted bile duct metal stent. One case had mild pancreatitis（11.1%, 1/9）, amylase increased in 3cases（33.3%, 3/9）.【Conclusion】ERCP is a safe and reliable diagnostic method, and plays an important role in the diagnosis and treatment of IPMN. Combined with pathology, it can provide definite diagnosis and reliable evidence before surgery.