合并十二指肠乳头旁憩室的胆胰疾病患者行经内镜逆行胰胆管造影的操作技巧

Operation skills of endoscopic retrograde cholangiopancreatography in pancreaticobiliary patients with periampullary duodenal diverticula

目的探讨合并十二指肠乳头旁憩室行经内镜逆行胰胆管造影术(ERCP)的操作技巧。方法回顾性分析2013年3月-2015年2月于山东省交通医院肝胆内镜科行ERCP合并十二指肠乳头旁憩室患者867例的临床资料,分析插管成功率、治疗效果及并发症发生情况。结果插管成功率99.8%,使用切开刀直接插管成功793例,采用双导丝及胰管支架占据44例,止血夹固定乳头法3例,预切开25例,2例未能成功插管。治疗过程中出现胰腺炎5例,穿孔1例,延迟性出血1例,经保守治疗后均治愈。结论 ERCP治疗合并十二指肠乳头旁憩室的胆胰疾病,应明确ERCP、内镜下乳头括约肌切开术适应证,根据乳头特点采用针对性的操作技巧,有助于提高成功率,减少并发症,是一种安全的微创治疗方法。

Objective To investigate the operation skills of endoscopic retrograde cholangiopancreatography（ ERCP） in patients with periampullary duodenal diverticula. Methods A retrospective analysis was performed for the clinical data of 867 patients with periampullary duodenal diverticula who underwent ERCP in Department of Hepatobiliary Endoscopy in Shandong Jiaotong Hospital from March 2013 to February 2015. The rate of successful intubation,therapeutic effect,and development of complications were analyzed. Results The rate of successful intubation was 99. 8%. Of all patients,793 underwent successful intubation with an incision knife,44 were treated with double guide wires and pancreatic duct stenting,3 underwent fixation of the papilla with hemostatic clips,25 underwent the pre- cut technique,and 2underwent failed intubation. There were 5 cases of pancreatitis,l case of perforation,l case of delayed bleeding,and all the patients were cured after conservative treatment. Conclusion When ERCP is used in the treatment of pancreaticobiliary diseases complicated by periampullary duodenal diverticula,the indications for ERCP and endoscopic sphincterotomy should be clarified. Targeted operation skills selected based on the features of the papilla help to improve the success rate and reduce complications,and therefore,it is a safe minimally invasive therapy.