内镜介入治疗对慢性胰腺炎的临床疗效(1)
【摘要】 目的探讨内镜介入治疗对慢性胰腺炎的临床疗效。方法 29例慢性胰腺炎患者行内镜介入治疗。其中,21例胰管扩张者行胰管括约肌切开(EPS);19例胰管有明显狭窄者置入胰管内支架(ERPD);12例副胰管扩张者则行副乳头括约肌切开并行副胰管内支架置入;8例胰管结石者先行EPS后用探条扩张狭窄段,再用网篮或气囊取石,若取石困难则做ERPD;平均每个月电话随访一次,必要时复查逆行胰胆管造影(ERCP)。结果 内镜介入治疗成功率 86.21% (25/29)。术后1、6、12个月时腹痛完全缓解率分别为75.86%、65.52%、68.97%;消瘦、脂肪泻等症状均不同程度得到改善,2例患者分别于术后第5个月及第11个月出现支架阻塞予更换支架治疗。术后并发一过性高淀粉酶血症7例,急性胰腺炎2例,出血2例,无穿孔发生,无中转手术或死亡。结论 内镜介入治疗具有安全、有效、创伤小的优点, 在治疗慢性胰腺炎方面应有较好的应用前景。
【关键词】 慢性胰腺炎;内镜介入治疗;逆行胰胆管造影(ERCP);胰管内支架(ERPD)
The clinical effects of interventional endoscopic therapy on the treatment of chronic pancreatitis
WEI Jin-qi,ZHOU Xiao-jun,BIAN Zhuang. Department of Gastroenterology, the 5th affiliated hospital of Sun Yet-Sen university,Guangdong 519000,China
【Abstract】 Objective To discuss theclinical effects of interventional endoscopic therapy on the treatment of Chronic Pancreatitis.Methods A total of 29 patients with chronic pancreatitis were treated with interventional endoscopic therapy. Among them, 21 patients underwent EPS. 19 patients were treated with ERPD;12 patients underwent minor papilla sphincterotomy and endoscopic stenting; 8 patients with stones were removed using basket or balloon. Afterwards, ERPD was performed if necessary. These patients were followed up every 1 months,ERCP were used if necessary. Results The successful rate of interventional endoscopic therapy was 86.21%,complete remission rate of abdominal pain was 75.86%,65.52%,68.97% at the 1,6,12 month, clinical symptoms such as marasmus and fatty diarrhea were markedly improved. The stent was replaced in 2 case after 5,11 month because of obstruction. After the treatment, 7 patients developed transient hyperamylasemia, 2 had acute pancreatitis, 2 had hemorrhage. No perforation, conversion to an open surgery, or death occurred in this series. Conclusion Interventional endoscopic therapy is safe, effective, minimally invasive, and will be the first choice for the treatment of the chronic pancreatitis.
【Key words】 Chronic pancreatitis;interventional endoscopic therapy; Retrograde cholangiopan creatography,ERCP;ERPD
慢性胰腺炎( chronic pancreatitis,CP)是由于各种不同的原因造成的胰腺组织和功能的持续、永久性损害,造成不同程度的腺泡萎缩、腺管变形、纤维化及钙化,并最终导致胰腺内、外分泌功能障碍,从而出现相应的临床症状[1]。传统的内科保守治疗效果差,外科手术创伤较大。近年随着内镜治疗技术的不断完善,CP的治疗得到了快速发展,其中内镜介入治疗特别是内镜下胰管内支架置入术取得了较好的疗效[1-6],并已成为首先治疗方案[2]。现将我院2002年2月至2009年10月应用胰管内支架技术治疗CP 29例的疗效报告如下。
1 资料与方法
1.1 一般资料 29例CP患者中男17例,女12例,年龄22～86岁,中位年龄56岁,病程3 d～26年,所有患者均有不同程度的腹痛症状,伴有消瘦、脂肪泻。胆道疾病13例(其中慢性胆囊炎、胆囊结石6例,胆总管结石4例,肝内胆管结石3例),有长期饮酒史5例,胰腺分裂12例,高脂血症3例,糖尿病3例。21例胰管扩张,19例胰管有明显狭窄,12例副胰管扩张,8例胰管结石,胰腺假性囊肿形成2例。所有患者均经内科治疗效果不佳。
1.2 诊断标准 本组患者确诊CP至少符合下列一项:①腹部X线、B超或CT发现胰腺结石、囊肿或钙化;②ERCP显示胰管改变,符合CP特征,并排除胰腺癌;③典型CP症状、体征、外分泌功能检查异常。
1.3 治疗方法 ①治疗仪器:Olympus TJF-240 电子十二指肠镜;美国Wilson-cook 公司生产塑料胰管支架、胰管扩张气囊、扩张探条、取石网篮。②治疗方法常规术前准备后行ERCP检查了解胆胰管情况,确认胆胰管狭窄的位置、长度及结石的大小、数量及其位置。21例胰管扩张者行EPS;19例胰管有明显狭窄者行ERPD;12例副胰管扩张者则行副乳头括约肌切开并行副胰管内支架置入术;8例胰管结石者先行EPS后用探条扩张狭窄段,再用网篮或气囊取石,若取石困难则做ERPD;根据胆胰管狭窄的程度及位置置入不同型号的支架,支架远端越过狭窄段1.0 cm左右,术毕,退出导丝及内镜,送返病房密切观察。
1.4 观察指标 ①观察有无ERCP术后并发症如急性胰腺炎,出血等,监测血淀粉酶、肝肾功能等;②出院后每个月电话随访一次,了解并登记患者病情变化如腹痛改善情况。如患者诉有上腹痛症状,即刻到医院接受进一步检查,必要时复查ERCP;③腹痛分级:O级 患者没有感觉腹部疼痛;I级 轻微腹痛,不需要服用止痛药物,不影响工作及休息;II级 感觉有腹痛,服用止痛药物可以缓解;III级 服用止痛药物腹痛仍不能缓解;④疗效评定标准 临床治愈 腹痛症状消失;有效 腹痛症状减少一个级别以上;无效 腹痛症状无缓解或加重。, http://www.100md.com(卫金歧 周小军 边壮)
【关键词】 慢性胰腺炎;内镜介入治疗;逆行胰胆管造影(ERCP);胰管内支架(ERPD)
The clinical effects of interventional endoscopic therapy on the treatment of chronic pancreatitis
WEI Jin-qi,ZHOU Xiao-jun,BIAN Zhuang. Department of Gastroenterology, the 5th affiliated hospital of Sun Yet-Sen university,Guangdong 519000,China
【Abstract】 Objective To discuss theclinical effects of interventional endoscopic therapy on the treatment of Chronic Pancreatitis.Methods A total of 29 patients with chronic pancreatitis were treated with interventional endoscopic therapy. Among them, 21 patients underwent EPS. 19 patients were treated with ERPD;12 patients underwent minor papilla sphincterotomy and endoscopic stenting; 8 patients with stones were removed using basket or balloon. Afterwards, ERPD was performed if necessary. These patients were followed up every 1 months,ERCP were used if necessary. Results The successful rate of interventional endoscopic therapy was 86.21%,complete remission rate of abdominal pain was 75.86%,65.52%,68.97% at the 1,6,12 month, clinical symptoms such as marasmus and fatty diarrhea were markedly improved. The stent was replaced in 2 case after 5,11 month because of obstruction. After the treatment, 7 patients developed transient hyperamylasemia, 2 had acute pancreatitis, 2 had hemorrhage. No perforation, conversion to an open surgery, or death occurred in this series. Conclusion Interventional endoscopic therapy is safe, effective, minimally invasive, and will be the first choice for the treatment of the chronic pancreatitis.
【Key words】 Chronic pancreatitis;interventional endoscopic therapy; Retrograde cholangiopan creatography,ERCP;ERPD
慢性胰腺炎( chronic pancreatitis,CP)是由于各种不同的原因造成的胰腺组织和功能的持续、永久性损害,造成不同程度的腺泡萎缩、腺管变形、纤维化及钙化,并最终导致胰腺内、外分泌功能障碍,从而出现相应的临床症状[1]。传统的内科保守治疗效果差,外科手术创伤较大。近年随着内镜治疗技术的不断完善,CP的治疗得到了快速发展,其中内镜介入治疗特别是内镜下胰管内支架置入术取得了较好的疗效[1-6],并已成为首先治疗方案[2]。现将我院2002年2月至2009年10月应用胰管内支架技术治疗CP 29例的疗效报告如下。
1 资料与方法
1.1 一般资料 29例CP患者中男17例,女12例,年龄22～86岁,中位年龄56岁,病程3 d～26年,所有患者均有不同程度的腹痛症状,伴有消瘦、脂肪泻。胆道疾病13例(其中慢性胆囊炎、胆囊结石6例,胆总管结石4例,肝内胆管结石3例),有长期饮酒史5例,胰腺分裂12例,高脂血症3例,糖尿病3例。21例胰管扩张,19例胰管有明显狭窄,12例副胰管扩张,8例胰管结石,胰腺假性囊肿形成2例。所有患者均经内科治疗效果不佳。
1.2 诊断标准 本组患者确诊CP至少符合下列一项:①腹部X线、B超或CT发现胰腺结石、囊肿或钙化;②ERCP显示胰管改变,符合CP特征,并排除胰腺癌;③典型CP症状、体征、外分泌功能检查异常。
1.3 治疗方法 ①治疗仪器:Olympus TJF-240 电子十二指肠镜;美国Wilson-cook 公司生产塑料胰管支架、胰管扩张气囊、扩张探条、取石网篮。②治疗方法常规术前准备后行ERCP检查了解胆胰管情况,确认胆胰管狭窄的位置、长度及结石的大小、数量及其位置。21例胰管扩张者行EPS;19例胰管有明显狭窄者行ERPD;12例副胰管扩张者则行副乳头括约肌切开并行副胰管内支架置入术;8例胰管结石者先行EPS后用探条扩张狭窄段,再用网篮或气囊取石,若取石困难则做ERPD;根据胆胰管狭窄的程度及位置置入不同型号的支架,支架远端越过狭窄段1.0 cm左右,术毕,退出导丝及内镜,送返病房密切观察。
1.4 观察指标 ①观察有无ERCP术后并发症如急性胰腺炎,出血等,监测血淀粉酶、肝肾功能等;②出院后每个月电话随访一次,了解并登记患者病情变化如腹痛改善情况。如患者诉有上腹痛症状,即刻到医院接受进一步检查,必要时复查ERCP;③腹痛分级:O级 患者没有感觉腹部疼痛;I级 轻微腹痛,不需要服用止痛药物,不影响工作及休息;II级 感觉有腹痛,服用止痛药物可以缓解;III级 服用止痛药物腹痛仍不能缓解;④疗效评定标准 临床治愈 腹痛症状消失;有效 腹痛症状减少一个级别以上;无效 腹痛症状无缓解或加重。, http://www.100md.com(卫金歧 周小军 边壮)