内镜逆行胰胆管造影在急性胆源性胰腺炎合并胆管微结石治疗中的应用

Application of endoscopic retrograde cholangiopancreatography for treatment of acute biliary pancreatitis with bile duct microlithiasis

目的探讨内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)在急性胆源性胰腺炎(acute biliary pancreatitis,ABP)合并胆管微结石治疗中的应用。方法回顾性分析2016年1月至2019年2月山东省立第三医院肝胆外科收治的21例ABP患者经内镜超声检查(endoscopic ultrasonography,EUS)发现合并胆管微结石进而行ERCP治疗的临床资料,比较患者术前术后实验室指标变化。结果ABP患者21例均顺利进行ERCP治疗,20例常规插管造影成功,1例行预切开插管成功。其中十二指肠镜检查发现乳头憩室9例,乳头过长7例,乳头狭窄5例,乳头萎缩3例,乳头炎4例。术中放置鼻胆管18例,球囊扩张17例,胰管支架植入15例,胆道支架植入3例。术后谷草转氨酶、谷丙转氨酶、总胆红素、直接胆红素、间接胆红素、血清淀粉酶、血清脂肪酶、胆汁淀粉酶较术前明显降低,差异均具有统计学意义(P<0.05)。随访1~3年,21例患者均无胆源性胰腺炎、胆总管结石的复发。结论ERCP是治疗ABP合并胆管微结石的有效方法。

Objective To explore the application of endoscopic retrograde cholangiopancreatography(ERCP)in treatment of acute biliary pancreatitis(ABP)combined with bile duct microlithiasis.Methods A retrospective analysis was conducted in 21 patients with ABP in the the Third Shandong Provincial Hospital between Jan.2016 and Feb.2019.All of the 21 patients were diagnosed as bile duct microlithiasis by endoscopic ultrasonography(EUS)and received ERCP treatment.The changes of laboratory indicators before and after ERCP were compared.Results All 21 cases were successfully treated with ERCP,among them 20 cases were successful in conventional intubation,and 1 case was successful in pre-incision and intubation.Among them,duodenoscopy revealed 9 cases of nipple diverticulum,7 cases of excessively long nipple,and 5 cases of nipple stenosis,3 cases of nipple atrophy,4 cases of papillitis.Among 21 patients,18 cases received intraoperative nasobiliary duct placement,17 cases received balloon dilatation,15 cases received pancreatic duct stent implantation,3 cases received biliary stent implantation.Postoperative aspartate aminotransferase and alanine aminotransferase,total bilirubin,direct bilirubin,indirect bilirubin,serum amylase,serum lipase,and bile amylase were significantly lower than those before ERCP(all P<0.05).During the 1~3 years of follow-up,all 21 patients had no recurrence of biliary pancreatitis or common bile duct stones.Conclusion This study suggests that ERCP is an effective treatment for ABP combined with bile duct microlithiasis.