经内镜逆行胰胆管造影在肝外胆管腺瘤诊治中的应用

Application of endoscopic retrograde cholangiopancreatography in treatment of extrahepatic biliary adenoma

目的探讨肝外胆管腺瘤的临床特征及经内镜逆行胰胆管造影（ERCP）在其诊断及治疗中的作用。方法回顾性分析2010年1月-2016年6月苏北人民医院消化内科收治的7例肝外胆管腺瘤患者的临床表现、影像学特点、ERCP治疗及随访情况。结果 7例患者入院排除手术禁忌后,择期行ERCP,术中胆管造影见胆管不同部位显影中断,均予以导丝引导下细胞刷检及超细活检钳胆管内活组织检查,病理提示胆管腺瘤,6例患者选择ERCP治疗,1例患者ERCP术后行胆总管空肠Roux-en-Y吻合术。术后随访6~12个月,6例患者恢复良好,1例患者术后2个月并发胆管炎。结论 ERCP作为微创检查手段,有助于明确病因和判断病情。当患者存在外科手术禁忌或暂时不愿选择外科手术时,ERCP可作为一种姑息性治疗手段,能很好的缓解患者临床症状。

Objective To investigate the clinical features of extrahepatic biliary adenoma and the role of endoscopic retrograde cholangiopancreatography（ ERCP） in the diagnosis and treatment of extrahepatic biliary adenoma. Methods A retrospective analysis was performed for the clinical manifestations,imaging findings,ERCP treatment,and follow- up data of 7 patients with extrahepatic biliary adenoma who were admitted to Department of Gastroenterology in The People＇s Hospital of Northern Jiangsu from January 2010 to June 2016. Results Selective ERCP was performed for 7 patients after the exclusion of surgical contraindications. Intraoperative cholangiography showed interruption of different parts of the bile duct,and brush cytology under the guidance of guide wire and bile duct biopsy with ultrafine biopsy forceps were performed for all patients. The pathological examination showed bile duct adenoma. Among these patients,6 were treated with ERCP and 1 was treated with Roux- en- Y choledochojejunostomy after ERCP. Conclusion As a minimally invasive examination,ERCP helps to determine the cause of the disease and evaluate patients＇ condition. When patients have surgical contraindications or are not willing to choose surgery,ERCP can be used as palliative therapy to relieve their clinical symptoms.