外科理论与实践

外科理论与实践 ›› 2021, Vol. 26 ›› Issue (01): 54-57.doi: 10.16139/j.1007-9610.2021.01.011

• 论著 • 上一篇    下一篇

正常胰胆管合流病人胆汁淀粉酶升高的病因分析及内镜治疗

林美举1, 张诚2, 杨玉龙2(), 马跃峰1, 张洪威1, 祁春春1   

  1. 1.大连大学附属中山医院胆石病微创外科,辽宁 大连 116001
    2.同济大学附属东方医院胆石中心 肝胆胰外科,同济大学医学院胆石病研究所,上海 200120
  • 收稿日期:2020-09-01 出版日期:2021-01-25 发布日期:2022-07-28
  • 通讯作者: 杨玉龙 E-mail:yyl516@126.com

Etiological analysis of elevation of bile amylase level in patients with normal pancreaticobiliary junction and endoscopic treatment

LIN Meiju1, ZHANG Cheng2, YANG Yulong2(), MA Yuefeng1, ZHANG Hongwei1, QI Chunchun1   

  1. 1. Department of Minimally Invasive Surgery for Cholelithiasis, Affilated Zhongshan Hospital of Dalian University, Dalian 116001, China
    2. Cholelithiasis Center, Department of Hepatobiliary and Pancreatic Surgery, Dongfang Hospital Affilated to Tongji University, Institute of Cholelithiasis, Tongji University School of Medicine, Shanghai 200120, China
  • Received:2020-09-01 Online:2021-01-25 Published:2022-07-28
  • Contact: YANG Yulong E-mail:yyl516@126.com

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摘要：

目的：探讨正常胰胆管合流胆汁淀粉酶升高的原因及内镜治疗效果。方法：回顾性分析2016年1月至2019年12月96例正常胰胆管合流行腹腔镜胆囊切除术病人。切除胆囊前抽取并测定胆囊胆汁淀粉酶（gallbladder bile amylase, GBA）。部分病人行十二指肠镜检查、内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography,ERCP）、内镜胰胆分流术（endoscopic pancreaticobiliary separation, EPBS）,并测定胆管胆汁淀粉酶（bile duct amylase, BDA）。结果：96例GBA平均值为（484.2±200.0） U/L。其中62例行十二指肠镜检查诊断为：乳头过长7例,乳头萎缩5例,乳头旁憩室4例,乳头肿瘤3例,乳头炎2例;乳头旁憩室并乳头炎26例,乳头旁憩室并乳头过长8例,乳头过长并乳头炎4例,乳头旁憩室并乳头萎缩3例。59例行ERCP,其中45例BDA高于正常（110 U/L）,且显著低于GBA[（386.9±137.3） U/L比（466.3±189.4） U/L,t=2.276,P=0.025]。45例均行EPBS,术后1个月再次行ERCP复查,BDA均恢复正常,平均值为（65.9±13.6） U/L。EPBS前、后BDA的差异具有显著统计学意义（P<0.001）。结论：胆胰管汇合部疾病是引起正常胰胆管合流病人胆汁淀粉酶升高的重要原因,EPBS是有效治疗方法。

关键词: 正常胰胆管合流, 胆囊胆汁, 淀粉酶, 内镜胰胆分流术

Abstract:

Objective To investigate the cause of elevation of bile amylase level in patients with normal pancreaticobiliary junction and the effect of endoscopic treatment. Methods The clinical data of 96 patients with normal pancreaticobi-liary junction who had laparoscopic cholecystectomy from January 2016 to December 2019 were retrospectively analyzed. Gallbladder bile was gotten before gallbladder resection and the amylase in bile was measured. Duodenoscopy, endoscopic retrograde cholangiopancreatography (ERCP), endoscopic pancreaticobiliary separation (EPBS) and bile duct amylase (BDA) was done in some cases. Results Gallbladder bile amylase (GBA) in all 96 cases was (484.2±200.0) U/L. Sixty-two cases had duodenoscopy. Diagnoses was as follows: long nipple: 7 cases; papillary atrophy: 5 cases; parapapillary diverticulum: 4 cases; papillary tumor: 3 cases; papillitis: 2 cases; parapapillary diverticulum and papillitis: 26 cases; parapapillary diverticulum and long nipple: 8 cases; long nipple and papillitis: 4 cases; parapapillary diverticulum and papillary atrophy: 3 cases. Fifty-nine cases had ERCP among whom 45 cases had elevated level of BDA[(386.9±137.3) U/L] higher than normal (110 U/L), but lower than GBA [(466.3±189.4) U/L] with significant difference (t=2.276, P=0.025). EPBS was performed in all 45 cases and ERCP was performed again one month later. BDA returned to normal [(65.9±13.6) U/L] with significant difference before EPBS and after (P<0.001). Conclusions Pancreaticobiliary junction disease might be an important cause of elevated bile amylase in patients with normal pancreaticobiliary junction. EPBS is an effective treatment.

Key words: Normal pancreaticobiliary junction, Gallbladder bile, Amylases, Endoscopic pancreaticobiliary separation

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