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）

doi:10.16139/j.1007-9610.2020.06.005

摘要/Abstract

摘要：

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。

关键词: 胰胆管汇合异常, 内镜逆行胰胆管造影术, 患儿, 先天性胆总管扩张

Abstract:

Objective To investigate the safety and effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and treatment of pediatric pancreaticobiliary maljunction(PBM). Methods A total of 74 children with PBM diagnosed by ERCP were enrolled. The clinical data with postoperative follow-up were analyzed. Results There were 32 cases with type A, 16 cases with type B, 23 cases with type C and 3 cases with type D based on the classification of PBM proposed by Japanese Study Group on PBM. The positive diagnostic rate of PBM was only 8% using MRCP. All children underwent endoscopic sphincteropapillotomy with endoscopic nasobiliary drain of which 69 cases(93.4%) were preceded with extraction of pancreatic protease emboli or stones. Pancreatic stent was followed in 2 cases. Seven cases (9.5%) had mild pancreatits after ERCP. No bleeding or cardiac laceration and perforations were found. The children had resection of extrahepatic bile duct combined with hepatic duct jejunum Roux-en-Y anastomotisis except for 7(9.5%) cases without biliary dilatation. Conclusions ERCP could be performed safely with effective diagnosis and treatment in pediatric PBM, and is an important procedure for children with PBM during early stage.

Key words: Pancreaticobiliary maljunction, Endoscopic retrograde cholangiopancreatography, Pediatric, Congenital common bile duct dilatation

中图分类号:

翁明哲, 翁昊, 陶怡菁, 顾钧, 张文杰, 王雪峰. 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）[J]. 外科理论与实践, 2020, 25(06): 468-472.

WENG Mingzhe, WENG Hao, TAO Yijing, GU Jun, ZHANG Wenjie, WANG Xuefeng. Endoscopic retrograde cholangiopancreatography in diagnosis and treatment of pediatric pancreaticobiliary maljunction：a report of 74 cases[J]. Journal of Surgery Concepts & Practice, 2020, 25(06): 468-472.

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参考文献 20

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一般情况	例数（n=74）
男	23(29.4)
年龄（岁）	3.9±2.6
Komi分型
B-P型	35（47.3）
P-B型	16（21.6）
复杂型	3（4.1）
未明确分型	20（27.0）
JSGPM分型
A型	32（43.2）
B型	16（21.6）
C型	23（31.1）
D型	3（4.1）
伴随症状
腹痛	70（94.6）
黄疸	31（41.9）
发热	45（60.8）
呕吐	56（75.7）
入院诊断
急性胰腺炎	4（5.4）
胆道感染	60（81.1）
梗阻性黄疸	31（41.9）
先天性胆道扩张	63（85.1）
术前影像学检查阳性	6（8.1）

JSGPM分型	A型（n=32）	B型（n=16）	C型（n=23）	D型（n=3）	P值
男	11(34.4)	5(31.3)	7(30.4)	0	0.73
年龄（岁）	1.5±0.6	4.2±1.5	3.5±2.1	4.8±3.6	<0.05
胆总管扩张
有	32(100)	9(56.2)	22(95.6)	3（100）	<0.05
无	0	7(43.8)	1(4.4)	0	<0.05
胆总管最大径（mm）	28.5±10.4	8.5±4.1	19.2±7.9	11.5±4.5	<0.05
共同通道长度（mm）	8.5±4.8	10.8±4.2	12.6±3.9	12.8±3.7	>0.05
蛋白酶栓	28（87.5）	13（81.3）	23(100)	3（100）	>0.05
胆总管结石	5(15.6)	1(6.3)	2(8.7)	0	<0.05
ERCP干预
乳头肌切开	32(100)	16(100)	23(100)	3(100)	>0.05
取石	29(90.6)	14（87.5）	23(100)	3(100)	>0.05
胰管支架	0	0	0	3(100)	<0.05
EMBD	32(100)	16(100)	23(100)	3(100)	>0.05
胆汁淀粉酶	81 531±53 122	79 531±58 149	89 413±52 145	74 112±33 123	>0.05
肝外胆管切除+ 肝管空肠Roux-en-Y吻合	32(100)	9(56.2)	23(100)	3(100)	<0.05