ERCP在胰管损伤中的应用

Application of endoscopic retrograde cholangiopancreatography in pancreatic duct injury

目的探讨ERCP在胰管损伤中的应用。方法回顾性分析2006年8月至2014年2月在上海交通大学医学院附属新华医院采用ERCP诊治的14例胰管损伤患者临床资料。其中男9例，女5例；年龄6—77岁，中位年龄58岁。闭合性胰腺损伤6例；胰腺术后并发胰瘘8例，其中胰体尾切除术3例，胰体尾切除术联合脾切除术5例。患者均签署知情同意书，符合医学伦理学规定。闭合性胰腺损伤患者行ERCP，根据造影结果按美国创伤外科协会（AAST）分级采取内镜下逆行胰管支架引流术（ERPD）、内镜下逆行胆管支架引流术（ERBD）＋ERPD联合手术等治疗措施。术后发生胰瘘患者行ERCP诊断和引流治疗。观察患者经ERCP诊治后的恢复情况及ERCP相关手术并发症发生情况。结果6例闭合性胰腺损伤患者均经ERCP确诊，其中AAST分级Ⅲ级4例，予ERPD治疗；IV级2例，予ERBD＋ERPD治疗。8例胰腺术后并发胰瘘患者均经ERCP发现主胰管损伤，确诊后行ERPD治疗，术后胰瘘愈合时间中位数为16（12—25）d。所有患者ERCP治疗期间均未发生严重并发症，治疗后均痊愈出院，患者的胆管及胰管支架均在出院3个月后拔除。结论ERCP不仅用于胰管损伤的明确诊断，而且还可用于治疗，具有安全、微创等优势。

Objective To investigate the application of endoscopic retrograde eholangiopancreatography （ERCP） in pancreatic duct injury. Methods Fourteen patients with pancreatic duct injury who were diagnosed and treated with ERCP in Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine between August 2006 and February 2014 were retrospectively analyzed. Among them, 9 were males and 6 were females, aged 6-77 years old with a median age of 58 years old. Six patients were diagnosed with closed pancreatic injury. Eight cases were complicated with pancreatic fistula after surgery, 3 of whom underwent distal pancreatectomy and 5 underwent distal pancreatectomy combined with splenectomy. The informed consents of all patients were obtained and the local ethical committee approval was received. Patients diagnosed with closed pancreatic injury underwent ERCP. According to the imaging result and American Association for the Surgery of Trauma （AAST） classification, therapeutic measures such as endoscopic retrograde pancreatic drainage （ERPD）, and endoscopic retrograde biliary drainage （ERBD） ＋ ERPD were performed. Patients with pancreatic fistula after surgery received ERCP for diagnosis and drainage therapy. The recovery status and incidence of ERCP-related complications after ERCP diagnosis and treatment were observed. Results Six cases were confirmed with closed pancreatic injury by ERCP. According to the AAST classification, 4 cases with grade 111 injury underwent ERPD, and 2 with grade IV injury underwent ERBD ＋ ERPD. Eight cases with pancreatic fistula after surgery were all found with pancreatic duct injury by ERCP and then underwent ERPD. The median healing time of pancreatic fistula after surgery was 16 （12-25）d. No severe complication was observed during the treatment of ERCP. All patients were recovered and discharged after ERCP treatment. Biliary and pancreatic duct stents were removed 3 months after discharge. Conelusions ERCP has the advantages of salty and minimally invasion for the diagnosis and treatment of pancreatic duct injury.