胰腺分裂症的内镜诊治方法及临床价值
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摘要
目的探讨胰腺分裂症(PD)内镜诊治的常规及补救方法、临床疗效和安全性。方法回顾性分析该院2014年1月-2016年12月经内镜下逆行胰胆管造影(ERCP)诊治的17例PD患者的临床病历资料,并电话回访患者症状改善及术后恢复情况。结果 17例PD患者,仅1例进行了再次内镜下治疗,共进行内镜下治疗18例次。内镜下治疗常规策略包括:副乳头括约肌切开术(MiES)、副胰管支架置入术(EDSi)及副乳头括约肌扩张术(MiED)。术中16例次手术过程顺利,2例次经过困难,但最终采用补救方法联合超声内镜(EUS)对接技术使手术成功。术后并发出血1例次,并发支架相关性胰腺炎2例次,无穿孔和发热等其他并发症发生。17例患者无1例失访,随访时间(16.3±9.4)个月,所有患者术后腹痛视觉模拟评分(VAS)较术前明显改善[(2.0±1.2)vs(7.0±1.8)分],差异有统计学意义(P <0.05)。结论内镜诊治PD具有安全、有效、创伤及并发症少等特点,可明显改善患者临床症状,值得临床推广。根据临床情况可选择常规方法诊治,对于插管困难患者,可联合EUS通过对接技术进行补救诊治。
Objective To evaluate the efficacy, safety and strategies of endoscopic diagnosis and treatment for sympotomatic pancreas divisum. Methods The clinical data of 17 patients who underwent endoscopic endoscopic retrograde cholangiopancreatography retrograde cholangiopancreatography from January 2014 to December 2016 in our hospital with the diagnosis of pancreas divisum was retrospectively analyzed. Improvement of symptoms and postoperative recovery in patients were followed-up by telephone. Results Only 2 cases, finally successfully rescue-treated by using the rendezvous technology, namely combination of the endoscopic ultrasonography, and the other 17 cases were operated successfully. 1 case complicated with hemorrhage. 2 cases complicated with stent associated pancreatitis. No perforation, fever or other complications occurred. The follow-up time was(16.3 ± 9.4) months, All these patients had significantly improved abdominal pain after operation, VAS score is(2.0 ± 1.2) vs.(7.0 ± 1.8)(P < 0.05). Conclusion The endoscopic diagnosis and treatment for sympotomatic pancreas divisum is safe, effective, minimally invasive and with less complications. What's more, it can significantly improve the clinical symptoms of patients, which is worth spreading in clinical works. According to the different clinical needs can choose MiES, MiED and EDSi. For patients of pancreas divisum, owing to the difficult cannulation and failed in the singleERCP procedure, rendezvous technology, namely combining with the endoscopic ultrasonography, can be a choise of remedial measures for diagnosis and treatment.
Objective To evaluate the efficacy, safety and strategies of endoscopic diagnosis and treatment for sympotomatic pancreas divisum. Methods The clinical data of 17 patients who underwent endoscopic endoscopic retrograde cholangiopancreatography retrograde cholangiopancreatography from January 2014 to December 2016 in our hospital with the diagnosis of pancreas divisum was retrospectively analyzed. Improvement of symptoms and postoperative recovery in patients were followed-up by telephone. Results Only 2 cases, finally successfully rescue-treated by using the rendezvous technology, namely combination of the endoscopic ultrasonography, and the other 17 cases were operated successfully. 1 case complicated with hemorrhage. 2 cases complicated with stent associated pancreatitis. No perforation, fever or other complications occurred. The follow-up time was(16.3 ± 9.4) months, All these patients had significantly improved abdominal pain after operation, VAS score is(2.0 ± 1.2) vs.(7.0 ± 1.8)(P < 0.05). Conclusion The endoscopic diagnosis and treatment for sympotomatic pancreas divisum is safe, effective, minimally invasive and with less complications. What's more, it can significantly improve the clinical symptoms of patients, which is worth spreading in clinical works. According to the different clinical needs can choose MiES, MiED and EDSi. For patients of pancreas divisum, owing to the difficult cannulation and failed in the singleERCP procedure, rendezvous technology, namely combining with the endoscopic ultrasonography, can be a choise of remedial measures for diagnosis and treatment.
引文
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[7]KANTH R,SAMJI N S,INAGANTI A,et al.Endotherapy in symptomatic pancreas divisum:a systematic review[J].Pancreatology,2014,14(4):244-250.
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[9]LAPP R T,HUTCHINS G F.Minor papilla adenoma management in patients with pancreas divisum and familial adenomatous polyposis[J].ACG Case Rep J,2013,1(1):47-50.
[10]ADIBELLI Z H,ADATEPE M,ISAYEVA L,et al.Pancreas divisum:A risk factor for pancreaticobiliay tumors-an analysis of1628 MR cholangiography examinations[J].Diagn Intev Imaging,2016,98(2):141-147.
[2]YAMAMOTO N,ISAYAMA H,SASAHIRA N,et al.Endoscopic minor papilla balloon dilation for the treatment of symptomatic pancreas divisum[J].Pancreas,2014,43(6):927-930.
[3]RUSTAGI T,GOLIOTO M.Diagnosis and therapy of pancreas divisum by ERCP:a single center experience[J].Journal of Digestive Diseases,2013,14(2):93-99.
[4]HANN A,WALTER B M,MEINING A.Use of a fully covered metal stent to treat obstruction of the minor papilla in pancreas divisum[J].Endoscopy,2016,48(S01):E390-E391.
[5]MICHAILIDIS L,ASLAM B,GRIGORIAN A,et al.The efficacy of endoscopic therapy for pancreas divisum:a meta-analysis[J].Ann Gastroenterol,2017,30(5):550-558.
[6]FUJIMORI N,IGARASHI H,ASOU A,et al.Endoscopic approach through the minor papilla for the management of pancreatic diseases[J].World J Gastrointest Endosc,2013,5(3):81-88.
[7]KANTH R,SAMJI N S,INAGANTI A,et al.Endotherapy in symptomatic pancreas divisum:a systematic review[J].Pancreatology,2014,14(4):244-250.
[8]庄耘,邵东,陈建平,等.胰胆管合流异常合并胰腺分裂症一例并文献复习[J].中华胰腺病杂志,2015,15(5):338-339.[8]ZHUANG Y,SHAO D,CHEN J P,et al.Anomalous junction of pancreaticobiliary ductal combine with pancreatic divisum:a report of one case and literature review[J].Chinese Journal of Pancreatology,2015,15(5):338-339.Chinese
[9]LAPP R T,HUTCHINS G F.Minor papilla adenoma management in patients with pancreas divisum and familial adenomatous polyposis[J].ACG Case Rep J,2013,1(1):47-50.
[10]ADIBELLI Z H,ADATEPE M,ISAYEVA L,et al.Pancreas divisum:A risk factor for pancreaticobiliay tumors-an analysis of1628 MR cholangiography examinations[J].Diagn Intev Imaging,2016,98(2):141-147.
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