胰腺分裂症的内镜治疗

ENDOSCOPIC TREATMENT IN PANCREAS DIVISUM

对长海医院 1993年 1月～2 0 0 1年 12月行内镜治疗的 5例PD患者的临床资料进行回顾分析。5例PD患者中 ,1例在导丝引导下用气囊导管对副乳头行扩张成形术 ;1例在导丝引导下行副乳头括约肌切开术 ,切开大小约 5mm ;3例行副乳头塑料探条 (7及8 5F)扩张。 3例行副胰管支架置入治疗 ,支架外径均为 7F ,长度分别为 3 5cm、5cm及 6cm。术后 2例 2 4h内血清淀粉酶高于正常 ,4 8h后恢复正常水平 ,未发现严重胰腺炎、出血及穿孔等并发症 ,近期腹痛缓解率为 10 0 %。随访 5～ 36个月 (平均 18个月 ) ,除 1例 8个月后因胰管支架阻塞再发腹痛 ,经更换支架后腹痛缓解 ,其余患者未再发腹痛 ,亦未发生支架移位及阻塞等远期并发症。提示对有症状的PD患者应积极行内镜治疗 ,尤其副胰管支架置入 ,可达到较好的胰液引流效果 ,缓解患者腹痛等症状。

To assess the therapeutic value of endoscopic treatment in pancreas divisum(PD), 5 cases of PD from January 1993 to December 2001 were involved and analyzed retrospectively. Dilatation of minor papilla by passage of a balloon was used in one patient, and tapered catheter passed over guide wire was used in three patients, whereas endoscopic minor papilla sphincterotomy was used in one patient. Pancreatic stents were put into the accessory pancreatic duct in three patients after endoscopic minor papilla dilatation or sphincterotomy. The diameter of the stents was 7F and the length was 3 5cm, 5cm and 6cm. Severe pancreatitis, hemorrage or perforation was not found after endoscopic treatment, except in two patients the serum amylase level elevated within 24h and returned normal after 48h. After endoscopic treatment the remission rate of abdominal pain was up to 100%. By follow up for 5～36 months (average 18 months), no relapse of abdominal pain and complications were found except one patient who had stent occlusion and replaced by a new stent. So endoscopic treatment is a safe and effective therapeutic technique for symptomatic PD and should be used as the first choice.