Endoscopic retrograde cholangiopancreatography in children with symptomatic pancreaticobiliary maljunction: A retrospective multicenter study

BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)has been widely used in pediatric patients with cholangiopancreatic diseases.AIM To evaluate the efficacy,safety,and long-term follow-up results of ERCP in symptomatic pancreaticobiliary maljunction(PBM).METHODS A multicenter,retrospective study was conducted on 75 pediatric patients who were diagnosed with PBM and underwent therapeutic ERCP at three endoscopy centers between January 2008 and March 2019.They were divided into four PBM groups based on the fluoroscopy in ERCP.Their clinical characteristics,specific ERCP procedures,adverse events,and long-term follow-up results were retrospectively reviewed.RESULTS Totally,112 ERCPs were performed on the 75 children with symptomatic PBM.Clinical manifestations included abdominal pain(62/75,82.7%),vomiting(35/75,46.7%),acholic stool(4/75,5.3%),fever(3/75,4.0%),acute pancreatitis(47/75,62.7%),hyperbilirubinemia(13/75,17.3%),and elevated liver enzymes(22/75,29.3%).ERCP interventions included endoscopic sphincterotomy,endoscopic retrograde biliary or pancreatic drainage,stone extraction,etc.Procedure-related complications were observed in 12 patients and included post-ERCP pancreatitis(9/75,12.0%),gastrointestinal bleeding(1/75,1.3%),and infection(2/75,2.7%).During a mean follow-up period of 46 mo(range:2 to 134 mo),ERCP therapy alleviated the biliary obstruction and reduced the incidence of pancreatitis.The overall effective rate of ERCP therapy was 82.4%;seven patients(9.3%)were lost to follow-up,eight(11.8%)re-experienced pancreatitis,and eleven(16.2%)underwent radical surgery,known as prophylactic excision of the extrahepatic bile duct and hepaticojejunostomy.CONCLUSION ERCP is a safe and effective treatment option to relieve biliary or pancreatic obstruction in symptomatic PBM,with the characteristics of minor trauma,fewer complications,and repeatability.

Rare variant of pancreaticobiliary maljunction associated with pancreas divisum in a child diagnosed and treated by endoscopic retrograde cholangiopancreatography: A case report

BACKGROUND Pancreaticobiliary maljunction(PBM) is an uncommon congenital anomaly of the pancreatic and biliary ductal system, defined as a union of the pancreatic and biliary ducts located outside the duodenal wall. According to the Komi classification of PBM, the common bile duct(CBD) directly fuses with the ventral pancreatic duct in all types. Pancreas divisum(PD) occurs when the ventral and dorsal ducts of the embryonic pancreas fail to fuse during the second month of fetal development. The coexistence of PBM and PD is an infrequent condition.Here, we report an unusual variant of PBM associated with PD in a pediatric patient, in whom an anomalous communication existed between the CBD and dorsal pancreatic duct.CASE SUMMARY A boy aged 4 years and 2 mo was hospitalized for abdominal pain with nausea and jaundice for 5 d. Abdominal ultrasound showed cholecystitis with cholestasis in the gallbladder, dilated middle-upper CBD, and a strong echo in the lower CBD, indicating biliary stones. The diagnosis was extrahepatic biliary obstruction caused by biliary stones, which is an indication for endoscopic retrograde cholangiopancreatography(ERCP). ERCP was performed to remove biliary stones. During the ERCP, we found a rare communication between the CBD and dorsal pancreatic duct. After clearing the CBD with a balloon, an 8.5 Fr 4-cm pigtail plastic pancreatic stent was placed in the biliary duct through the major papilla. Six months later, his biliary stent was removed after he had no symptoms and normal laboratory tests. In the following 4-year period, the child grew up normally with no more attacks of abdominal pain.CONCLUSION We consider that ERCP is effective and safe in pediatric patients with PBM combined with PD, and can be the initial therapy to manage such cases,especially when it is combined with aberrant communication between the CBD and dorsal pancreatic duct.

Application of endoscopic retrograde cholangiopancreatography in the diagnosis and treatment of pancreaticobiliary disease

Objective: To validate endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis andtreatment of pancreaticobiliary disease and to improve the methodology of ERCP. Methods: From January 1977 toJune 1998, Seven thousand two hundred and thirty eight patients who were suspected to have pancreaticobiliaryduct diseases were examined with ERCP. Those who had therapeutic indications received ERCP treatment such asdrainage, dilatation and lithotomy. All cases were reviewed retrospectively, and analyzed for the clinical value andcomplications of ERCP. Results: In 7 238 patienls who underwent 7 579 ERCPs, the total success rate was94. 8%, with a 75. 7% showing rate of pancreatic duct. and 89. 1 % of the binary duct, revealing 3 492 cases ofbinary duct disease, 570 cases of pancreatic duct disease. 821 cases of diverticula and 171 cases of fistula. of which921 cases were treated endoscopically. The rate of complications arising from diagnostic ERCP was 1. 01%.without a single death, the rate of complications arising from therapeutic ERCP was 1. 3 %, two patients died(0. 22 % ). Conclusion: ERCP has important clinical value in the diagnosis and treatment of pancreaticobiliary ductdisease.

Intraoperative endoscopic retrograde cholangiopancreatography for traumatic pancreatic ductal injuries:Two case reports

BACKGROUND In order to successfully manage traumatic pancreatic duct(PD)leaks,early diagnosis and operative management is paramount in reducing morbidity and mortality.In the acute setting,endoscopic retrograde cholangiopancreatography(ERCP)can be a useful,adjunctive modality during exploratory laparotomy.ERCP with sphincterotomy and stent placement improves preferential drainage in the setting of injury,allowing the pancreatic leak to properly heal.However,data in this acute setting is limited.CASE SUMMARY In this case series,a 27-year-old male and 16-year-old female presented with PD leaks secondary to a gunshot wound and blunt abdominal trauma,respectively.Both underwent intraoperative ERCP within an average of 5.9 h from time of presentation.A sphincterotomy and plastic pancreatic stent placement was performed with a 100%technical and clinical success.There were no associated immediate or long-term complications.Following discharge,both patients underwent repeat ERCP for stent removal with resolution of ductal injury.CONCLUSION These experiences further demonstrated that widespread adaption and optimal timing of ERCP may improve outcomes in trauma centers.

Safety of endoscopic retrograde cholangiopancreatography in pregnancy: Fluoroscopy time and fetal exposure, does it matter?

AIM: To estimate the fetal radiation exposure using thermoluminescent dosimeters (TLD's) in pregnant patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and assess its relevance. METHODS: Data on thirty-five therapeutic ERCPs conducted in pregnant patients from 2001 to 2009 were retrieved from a prospective database. Techniques to minimize fluoroscopy time were implemented and the fluoroscopy times captured. TLD's were placed on the mother to estimate the fetal radiation exposure and the results were compared to the maximum allowed dose of radiation to the fetus [0.005 gray (Gy)]. Obstetrics consultations were obtained and the fetus was monitored before and after the ERCP. Fluoroscopy wasperformed at 75 kVp. ERCP was performed with the patients supine by dedicated biliary endoscopists performing more than 500 cases a year. RESULTS: A total of 35 pregnant patients underwent ERCP and biliary sphincterotomy (14 in first trimester, 11 in second trimester, and 10 in third trimester). Mean maternal age was 25 years (range 16-37 years) and mean gestational age was 18.9 wk (range 4-35 wk). Mean fluoroscopy time was 0.15 min (range 0-1 min). For 23 women, the estimated fetal radiation exposure was almost negligible (< 0.0001 Gy) while for 8 women, it was within the 0.0001-0.0002 Gy range. Three women had an estimated fetal radiation exposure between 0.0002 and 0.0005 Gy and 1 woman had an estimated fetal radiation exposure greater than 0.0005 Gy. Complications included 2 post-sphincterotomy bleeds, 2 post-ERCP pancreatitis, and 1 fatal acute respiratory distress syndrome. One patient developed cholecystitis 2 d after ERCP. CONCLUSION: ERCP with modified techniques is safe during pregnancy, and estimating the fetal radiation exposure from the fluoroscopy time or measuring it via TLD's is unnecessary.

Diagnostic and therapeutic role of endoscopic retrograde cholangiopancreatography in biliary rhabdomyosarcoma

Biliary rhabdomyosarcoma (BRMS) is an uncommon childhood malignancy which has been managed surgically. We present a case of a 3-year-old boy with BRMS, in whom endoscopic retrograde cholangiopancreatography (ERCP) was successfully used both diagnostically and therapeutically, thus obviating the need for surgery and its attendant risks of morbidity and mortality. We conclude that ERCP is an effective alternative to surgery for BRMS in some patients.

Endoscopic retrograde cholangiopancreatography and liver biopsy in the evaluation of elevated liver function tests after liver transplantation

BACKGROUND Abnormal liver function tests(LFTs)in post-liver transplant(LT)patients pose a challenge in the timing and selection of diagnostic modalities.There are little data regarding the accuracy of endoscopic retrograde cholangiopancreatography(ERCP)and liver biopsy(LB)in diagnosing post-transplant complications.AIM To evaluate the diagnostic performance of ERCP and LB in patients with nonvascular post-LT complications.METHODS This single-center retrospective study evaluated patients undergoing both ERCP and LB for evaluation of elevated LFTs within 6 mo of LT from 2000 to 2017.Diagnostic operating characteristics including accuracy,sensitivity and specificity for various diagnoses were calculated for ERCP and LB.The R factor(ratio of alkaline phosphatase to alanine aminotransferase)was also calculated for each patient.RESULTS Of the 1284 patients who underwent LT,91 patients(74.7%males,mean age of 51)were analyzed.Anastomotic strictures(AS,24.2%),acute cellular rejection(ACR,11%)and concurrent AS/ACR(14.3%)were the most common diagnoses.ERCP carried an accuracy of 79.1%(95%CI:69.3-86.9),LB had an accuracy of 93.4%(95%CI:86.2-97.5),and the combination of the two had an accuracy of 100%(95%CI:96-100).There was no difference between patients with AS and ACR in mean R factor(AS:1.9 vs ACR:1.1,P=0.24).Adverse events did not differ between the two tests(ERCP:3.1%vs LB:1.1%,P=0.31).CONCLUSION In patients with abnormal LFTs after LT without vascular complications,the combination of LB and ERCP carries low risk and improves diagnostic accuracy over either test alone.

Appropriate number of biliary biopsies and endoscopic retrograde cholangiopancreatography sessions for diagnosing biliary tract cancer

BACKGROUND Biliary ductal cancer(BDC) is a lethal disease; however, diagnosing BDC is challenging. Biliary biopsies are performed to pathologically diagnose BDC, but the appropriate parameters for biliary biopsy [number of biliary biopsies, number of endoscopic retrograde cholangiopancreatography(ERCP) sessions, etc.] are unknown.AIM To clarify what constitutes an adequate method for biliary biopsy.METHODS In total, 95 patients who underwent endoscopic biliary biopsy without choledochoscopy and who were pathologically diagnosed with BDC were enrolled in this study. The patients were divided into two groups. Seventy-six patients who were diagnosed by biliary biopsy were defined as the positive group(P group), and nineteen patients who were not diagnosed by biliary biopsy were defined as the negative group(N group). The patient characteristics and ERCP-related procedures were compared between the P and N groups.RESULTS The numbers of ERCP sessions and biliary biopsies were significantly different between the two groups [ERCP sessions(one/two), P group 72/4 vs N group15/4, P value = 0.048; number of biliary biopsies, P group 2(1-6) vs N group 2(1-7), P value = 0.039]. In a multivariate analysis, fewer than 2 ERCP sessions was an independent factor influencing the positivity of the biliary biopsies.CONCLUSION This study clarified that ERCP and biliary ductal biopsy should only be performed once. If biliary cancer is not pathologically diagnosed after the first ERCP session, other methods(Endoscopic ultrasonography-guided fine needle aspiration or choledochoscopy-guided biliary ductal biopsy) should be employed.

Rare post-endoscopic retrograde cholangiopancreatography complications:Can we avoid them?

Regarded as a minimally invasive procedure,endoscopic retrograde cholangiopancreatography(ERCP)is commonly used to manage various pancreaticobiliary disorders.The rate of complications is low and starts from 4%for diagnostic interventions.The group of most frequent negative outcomes is commonly known and includes pancreatitis,cholecystitis,and hemorrhage.Rare adverse effects occur occasionally but carry a significant risk of unexpected and potentially dangerous results.In some cases,including splenic injury,the knowledge of pre-existing conditions might be helpful in avoiding the unwanted outcome,while in others,the risk factors are not clearly defined.Such situations demand increased caution in the post-ERCP period.The appearance of abdominal pain,peritoneal symptoms,or instability of the patient’s hemodynamic condition should alert the physician and lead to further investigation of the possible causes.The diagnostic process usually involves imaging tests.The implementation of the appropriate treatment should be immediate,as many of the rare complications carry the risk of dangerous,even potentially lethal,results.

Endoscopic diagnosis of pancreaticobiliary maljunction

Pancreaticobiliary maljunction (PBM) is a congenital anomaly defined as a junction of the pancreatic and bile ducts located outside the duodenal wall, usually forming a markedly long common channel. As the action of the sphincter of Oddi does not functionally affect the junction in PBM patients, continuous pancreatobiliary reflux occurs, resulting in a high incidence of biliary cancer. PBM can be divided into PBM with biliary dilatation (congenital choledochal cyst) and PBM without biliary dilatation (maximal diameter of the bile duct ≤ 10 mm). The treatment of choice for PBM is prophylactic surgery before malignant changes can take place. Endoscopic retrograde cholangiopancreatography (ERC P) is the most effective examination method for close obs ervation of the pattern of the junction site. When the communication between the pancreatic and bile ducts is maintained, despite contraction of the sphi ncter on ERCP, PBM is diagnosed. In these pat ients, levels of pancreatic enzymes in the bile are gene rally elevated, due to continuous pancreatobiliary reflux via a long common channel. Magnetic resonance cholangiopancreatography and 3D-computed tomography can diagnose PBM, based on findings of an anomalous union between the common bile duct and the pancreatic duct, in addition to a long common channel. Endoscopic ultrasonography and intraductal ultra sonography can demonstrate the junction outside the duodenal wall, and are useful for the diagnosis of asso ciated biliary cancer. Gallbladder wall thickness on ultra so nography can be a screening test for PBM.

Application of imaging techniques in pancreaticobiliary maljunction

Imaging techniques are useful tools in the diagnosis and treatment of pancreaticobiliary maljunction(PBM).PBM is a precancerous lesion often relative to the disease of the pancreas and biliary tract,for example,cholecystolithiasis,protein plugs,and pancreatitis.For patients with PBM,early diagnosis and timely treatment are highly important,which is largely dependent on imaging techniques.The continuous development of imaging techniques,including endoscopic retrograde cholangiopancreatography,magnetic resonance cholangiopancreatography,computed tomography,ultrasound,and intraoperative cholangiography,has provided appropriate diagnostic and therapeutic tools for PBM.Imaging techniques,including non-invasive and invasive,have distinct advantages and disadvantages.The purpose of this paper is to review the application of various imaging techniques in the diagnosis and treatment of PBM.

儿童经内镜逆行胰胆管造影术后胰腺炎发生的危险因素分析

目的探讨经内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)在儿童患者应用中术后胰腺炎(post-ERCP pancreatitis,PEP)发生的危险因素。方法回顾性分析2013年9月—2023年9月在昆明医科大学第二附属医院消化内镜中心因胆胰疾病接受ERCP诊疗的66例年龄≤16岁患儿的临床资料,分析PEP的发生率及相关影响因素。结果66例患儿共进行ERCP 78例次,诊断性ERCP 5例次,治疗性ERCP 69例次,操作失败4例次,ERCP操作成功率为95%(74/78)。术后共有17例次发生胰腺炎,发生率为22%。PEP组患儿术前胆红素正常比例、术中导丝探插入胰管比例高于非PEP组(P<0.05)。多因素logistic回归分析显示,导丝探插入胰管为儿童ERCP PEP发生的危险因素(P<0.05)。结论随着ERCP在儿童胆胰疾病中应用逐渐增多,术中应选择合适的插管技术,避免导丝盲目进入胰管,减少PEP的发生。

线阵超声内镜引导精准内镜十二指肠乳头括约肌切开术对胆总管结石患者内镜逆行胰胆管造影术后胆囊功能的影响

目的探讨线阵超声内镜引导精准内镜十二指肠乳头括约肌切开术(EST)对胆总管结石患者内镜逆行胰胆管造影术(ERCP)的术后胆汁淀粉酶(BA)、胆汁细菌阳性率和隐匿性胰胆反流(OPBR)的影响。方法选择2021年6月-2023年2月在该院进行ERCP的146例胆总管结石患者作为研究对象,患者需要行EST,根据EST的不同分为两组,各73例。观察组接受线阵超声内镜引导精准EST治疗,对照组行传统EST治疗。观察两组患者手术情况。比较术前、术后1和3 d两组患者肝功能指标[总胆红素(TBiL)、综合胆红素(CB)和丙氨酸转氨酶(ALT)等]、炎症和应激指标[C反应蛋白(CRP)、高迁移率族蛋白B1(HMGB1)、皮质醇(Cor)和去甲肾上腺素(NE)等],以及BA和胆汁细菌阳性率。统计两组患者手术并发症和术后12个月复发情况。结果两组患者取石成功率和手术时间比较,差异均无统计学意义(P>0.05)。观察组术中出血量少于对照组,住院时间短于对照组,差异均有统计学意义(P<0.05)。术后1和3 d,两组患者TBiL、CB和ALT低于术前,差异均有统计学意义(P<0.05),组间比较,差异均无统计学意义(P>0.05)。术后1和3 d,两组患者血清CRP、HMGB1、Cor和NE水平及BA浓度高于术前,观察组低于对照组,差异均有统计学意义(P<0.05)。对照组术后1和3 d胆汁细菌阳性率高于术前,差异有统计学意义(P<0.05),观察组手术前后各时点胆汁细菌阳性率比较,差异无统计学意义(P>0.05),观察组术后1和3 d胆汁细菌阳性率低于对照组(P<0.05)。观察组OPBR发生率和术后12个月复发率(15.07%和1.37%)低于对照组(57.53%和10.96%),差异均有统计学意义(P<0.05)。结论线阵超声内镜引导精准EST相对于传统EST,能有效减少十二指肠乳头括约肌损伤,避免肠胆反流,抑制BA分泌及细菌增殖,降低OPBR的发生风险。

十二指肠镜治疗儿童无明显胆管扩张型胰胆管合流异常的疗效及预后分析

目的探讨十二指肠镜治疗无明显胆管扩张型胰胆管合流异常(pancreaticobiliary maljunction without obvious biliary dilatation,PBM-nonOBD)患儿的手术疗效及预后不良相关因素。方法回顾性分析复旦大学附属儿科医院自2020年1月至2022年12月收治的内镜治疗PBM-nonOBD患儿的临床资料(包括人口学资料、临床症状、实验室检查及影像学资料),并对患儿进行随访。采用单因素分析及多因素Logistic回归分析十二指肠镜治疗PBM-nonOBD患儿不良预后的危险因素,并绘制受试者工作特征(receiver operating characteristic,ROC)曲线分析相关危险因素的预测价值。结果本研究共纳入44例患儿,随访时间(19.7±8.6)个月,治愈率为54.5%(24/44),其中治疗有效24例(为治疗有效组),治疗无效20例(为治疗无效组)。术后不良事件以十二指肠镜逆行性胆胰管造影术后胰腺炎最常见(7/44,15.9%),其中27.3%(12/44)的患儿最终需接受根治术,15.9%(7/44)的患儿需接受再次内镜治疗。治疗有效组胰胆管合流异常(pancreaticobiliary maljunction,PBM)分型以B型和D型为主,占比分别为41.7%(10/24)和37.5%(9/24)。单因素分析结果显示,年龄偏小、胰胆共同管直径较长、胆总管最宽直径较宽是PBM-nonOBD患儿内镜手术后预后不良的相关因素(P<0.05);多因素Logistic回归分析发现,年龄偏小(OR=1.645,95%CI:1.645~2.309)及胰胆共同管直径较长(OR=0.720,95%CI:0.720~0.968)是PBM-nonOBD患儿预后不良的独立危险因素(P<0.05),曲线下面积(area under the ROC curve,AUC)分别为0.838(95%CI:0.719~0.958)和0.731(95%CI:0.567~0.894),最佳截断值分别为4.9岁和8.8 mm。结论十二指肠镜手术创伤小,不会导致严重并发症,可有效缓解部分PBM-nonOBD患儿症状;年龄偏小和胰胆共同管长度较长可能与十二指肠镜治疗PBM-nonOBD预后不良相关。

内镜逆行胰胆管造影在胰胆管合流异常诊治中的应用

胰胆管合流异常(PBM)是一种胆胰管发育异常的先天性畸形,长期发展会导致胆胰系统肿瘤的发生,因此早发现早诊治是一个重点。内镜逆行胰胆管造影术(ERCP)作为PBM的诊断金标准,不仅能缓解急性临床症状,而且可以作为后期外科手术的桥接手段。

快速康复外科在胆道结石患者ERCP术后饮食管理中的应用

目的探讨快速康复外科理念用于胆管结石患者ERCP术后饮食管理的效果。方法选择60例拟行ERCP取石的胆管结石患者,随机分为观察组与对照组各30例,两组患者术后当天均常规禁食。观察组患者术后次日如腹痛的症状及体征均不明显,且血淀粉酶正常或基本正常,则开始进食。对照组患者术后次日如腹痛的症状及体征均不明显,且血淀粉酶完全正常,则开始进食,否则延长观察期,继续禁食,直至结果正常后再逐步过渡到流质饮食及普食。比较两组患者术后口渴、饥饿感、输液量、住院时间的差异。结果观察组患者术后口渴、饥饿感发生率低于对照组;术后输液量、住院时间少于对照组。差异均有统计学意义(P<0.05)。均未发生出血、穿孔、胰腺炎的并发症。结论在胆管结石患者ERCP术后应用快速康复外科理念是安全、有效的,缩短了术后禁食时间,加快了病人康复速度,缩短了住院时间。

十二指肠乳头旁憩室与胆胰疾病关系的临床研究

目的:探讨十二指肠乳头旁憩室(PAD)与胆胰疾病的关系。方法:通过回顾性研究,分析我院494例行ERCP及上消化道造影检查发现PAD的状况,观察PAD的检出率及PAD与胆系结石、胰腺炎的关系。结果:494例共检出PAD103例,检出率为20.9%;PAD合并胆系结石78例,发生率为75.7%,明显高于非PAD病例的44.3%(173/391);PAD合并胰腺炎14例,发生率为13.6%,明显高于非PAD病例的5.4%(21/391);PAD组的平均年龄为(65.2±11.6)岁,明显高于非PAD组的(53.3±15.8)岁,而且PAD的检出率随着年龄的增长而明显升高。PAD的检出率与性别无明显关系。结论:PAD与胆胰疾病的发生有着密切关系。PAD的检出率随着年龄的增长而增长。

治疗性经内镜逆行胰胆管造影术102例分析

目的探讨治疗性经内镜逆行胰胆管造影术(ERCP)在胆胰疾病中的应用价值。方法对102例经ERCP治疗的病例进行回顾性分析,其中EST58例、EPBD24例、ENBD34例,ERBD7例。结果治疗性ERCP成功率97/102(95.1%),其中胆石症61例(62.9%),胆总管下端良性狭窄13例(13.4%),胆胰肿瘤10例(10.3%,)胰腺炎5例(5.2%),化脓性胆管炎3例(3.1%),胆蛔2例(2.1%),胰管结石1例(1%),硬化性胆管炎1例(1%)、胆道畸形1例(1%),并发症发生率9/97(9.3%)。结论对于胆胰疾病治疗性ERCP是一种有效的微创治疗手段,能替代部分传统外科手术。

内镜逆行胰胆管造影在小儿胰胆管汇合异常中的诊疗作用(附74例报告)

目的:探讨内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography, ERCP)在诊断和治疗小儿胰胆管汇合异常(pancreaticobiliary maljunction, PBM)中的安全性和有效性。方法:回顾性分析本院ERCP确诊为PBM的74例患儿,分析临床资料和术后随访。结果 :按照日本胆胰管合流异常研究组(Japanese Study Group on Pancreaticobiliary Maljunction, JSGPM)分型,A型32例,B型16例,C型23例,D型3例。MRCP检查的阳性诊断率仅8%。本研究所有患儿均行乳头肌切开和鼻胆管引流。其中69例(93.4%)行取石/蛋白酶栓,2例术后留置胰管支架。7例(9.5%)术后出现ERCP后轻型胰腺炎,无术后出血、贲门撕裂及穿孔等严重并发症发生。除7例(9.5%)PBM不合并胆道扩张的患儿外,其余术后均行肝外胆管切除+肝管空肠Roux-en-Y吻合术。结论:ERCP在小儿PBM的诊治过程中具有诊断效力强、疗效好、安全性高的优点,对早期确诊并干预PBM的病理进程具有重要意义。

ERCP在先天性胆总管囊肿的诊治作用

目的回顾性分析内镜下胰胆管造影术(ERCP)对先天性胆总管囊肿(CCC)的诊断作用,探讨其发病机制;初步总结内镜治疗原则并评价其在外科术前的效果。方法造影后辨别CCC的分型、与合并其他胰胆管疾病的关系;根据分型,选择乳头括约肌切开、取石、胆道引流等内镜治疗或外科手术。结果发现CCC 13例,包括Ⅰa型8例,Ⅰc型1例,Ⅲ型1例,Ⅳa型3例;合并胰胆管合流异常(PBM)10例,无合并PBM者3例。伴胆管结石9例(Ⅰa型5例,Ⅲ型1例,Ⅳa型3例),7例内镜下取石成功,取石后置入胆管支架引流4例,行鼻胆管引流2例;Ⅲ型者仅行乳头括约肌切开取石;2例因胆管狭窄扩张无效或结石过大,未予取石,仅置入胆管支架引流。合并胰管结石1例,取石后置入胰管支架。内镜治疗后临床症状均明显缓解。结论 CCC与PBM有密切的关联;根据合并症的具体情况,采取相应的内镜治疗措施,ERCP胆道取石和/或置管引流在外科术前是有效的、必要的。