单气囊小肠镜辅助内镜逆行胰管造影治疗胰肠吻合口狭窄的临床应用

doi:10.16139/j.1007-9610.2026.01.09

摘要/Abstract

摘要：

目的：评估胰肠吻合口狭窄(PJS)病人单气囊小肠镜（SBE）辅助内镜逆行胰管造影（ERP）的可行性、有效性和远期疗效。方法：回顾性分析2016年3月至2021年3月接受SBE辅助ERP的16例PJS病例，评估技术操作成功、不良事件、失败风险因素和长期随访结果。结果：16例中8例治疗成功，成功率为50%，ERP后无严重并发症发生，胰空肠吻合部位辨认失败的危险因素包括消化道Child重建(P=0.001)、胰空肠黏膜对黏膜吻合(P=0.001)、术中未放置胰管支架(P=0.037)、术前胰管不扩张(P=0.037)和术后胰瘘(P=0.001)。此外，吻合口辨认成功组胰十二指肠切除(PD)术后首次出现腹痛间隔时间明显长于失败组（44.7个月比19.9个月，P=0.044），而出现症状至首次ERP干预时间短于失败组（8.4个月比22.4个月，P=0.021）。随访期间[77.2（6.8，187.7）个月]，复发率为25%，7例内镜胰管引流术治疗病人的支架置入总时间为62.3（6.8，153.7）个月，ERP治疗成功后未复发病人的体质量指数（BMI）变化均值为+2.46 kg/m²，而复发病人为-1.09 kg/m²，ERP治疗失败病人为-2.12 kg/m²。结论：PD后PJS的SBE辅助ERP治疗显示出良好的安全性、有效性和持久的疗效。一旦发生PJS，应及早进行ERP干预并放置胰管支架，以减少吻合口狭窄的复发。BMI是随访的重要监测指标。

关键词: 胰十二指肠切除术, 胰肠吻合口狭窄, 内镜逆行胰管造影, 单气囊小肠镜

Abstract:

Objective To evaluate the feasibility, effectiveness, and long-term outcome of single balloon enteroscopy(SBE)-assisted endoscopic retrograde pancreatography(ERP) in patients with pancreaticojejunal anastomotic stenosis (PJS). Methods The clinical data of 16 PJS cases undergoing SBE-assisted ERP from March 2016 to March 2021 were retrospectively reviewed. Technical and clinical success, adverse events, risk factors for failure and long-term outcomes were assessed. Results Eight of 16 patients were successfully treated, the success rate was 50%. No serious complications after ERP occurred. Risk factors for failure of pancreaticojejunostomy site identification included digestive tract Child reconstruction sequence (P=0.001), pancreaticojejunostomy method (P=0.001), without pancreatic duct support tube placement (P=0.037), undilated preoperative pancreatic duct (P=0.037) and postoperative pancreatic fistula (P=0.001). The interval between the first occurrence of abdominal pain after pancreaticoduodenectomy (PD) operation in the successful anastomotic site identification group was significantly longer than that in the failed group（44.7 months vs. 19.9 months, P=0.044）, while the time from symptom onset to the first ERP intervention was shorter than that in the anastomotic site identification failed group （8.4 months vs. 22.4 months, P=0.021）. During the follow-up periods [77.2(6.8, 187.7)months], recurrence rates were 25%. The total duration of stent placement in 7 patients with endoscopic pancreatic drainage treatment was 62.3 (6.8, 153.7). Body mass index (BMI) variation is +2.46 kg/m² in non-recurrence group compare to -1.09 kg/m² in recurrence group and -2.12 kg/m² in ERP treatment failure group. Conclusions SBE-assisted ERP treatment for PJS after PD showed favorable safety, effectiveness and durable long-term outcomes. ERP intervention should be carried out early once PJS occurs. BMI is an important index to be monitored during the follow-up of PJS patients.

Key words: Pancreaticoduodenectomy (PD), Pancreaticojejunostomy anastomotic stenosis (PJS), Endoscopic retrograde pancreatography (ERP), Single balloon enteroscopy (SBE)

中图分类号:

R657.5

周学平, 翁昊, 翁明哲, 束翌俊, 赵铭宁, 顾钧, 王雪峰. 单气囊小肠镜辅助内镜逆行胰管造影治疗胰肠吻合口狭窄的临床应用[J]. 外科理论与实践, 2026, 31(01): 50-57.

ZHOU Xueping, WENG Hao, WENG Mingzhe, SHU Yijun, ZHAO Mingning, GU Jun, WANG Xuefeng. Application of single balloon enteroscopy-assisted endoscopic retrograde pancreatography in patients with pancreaticojejunal anastomotic stenosis[J]. Journal of Surgery Concepts & Practice, 2026, 31(01): 50-57.

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Factors	Anastomotic site identification success(n=7)	Anastomotic site identification failure(n=7)	t value	P value
The time of first abdominal pain after the operation (month)	44.7	19.9	2.251	0.044
The time from the operation to the first ECRP treatment (month)	53.1	42.3	0.927	0.372
The time from the symptom onset to ERP treatment (month)	8.4	22.4	-2.658	0.021

Factors	Category	Anastomotic site identification success	Anastomotic site identification failure	χ² value	P value
Age (year)	<60	3	3	0.000	1.000
Age (year)	≥60	4	4	0.000	1.000
Sex	Male	4	3	0.265	0.606
Sex	Female	3	4	0.265	0.606
The primary disease (benign or malignant)	Benign	4	4	0.000	1.000
The primary disease (benign or malignant)	Malignant	3	3	0.000	1.000
Digestive tract reconstruction method	Child	7	3	5.200	0.001
Digestive tract reconstruction method	Whipple	0	4	5.200	0.001
Methods of pancreaticojejunostomy	Invagination	4	0	5.200	0.001
Methods of pancreaticojejunostomy	Duct to mucosa	3	7	5.200	0.001
Pancreatic duct dilation before PD	Yes	6	2	4.333	0.037
Pancreatic duct dilation before PD	No	1	5	4.333	0.037
Pancreatic duct tube placement during PD	Yes	6	2	4.333	0.037
Pancreatic duct tube placement during PD	No	1	5	4.333	0.037
Postoperative pancreatic fistula	Yes	1	6	6.633	0.010
Postoperative pancreatic fistula	No	6	1	6.633	0.010
Pancreatic duct dilation before ERP	Yes	3	3	0.000	1.000
Pancreatic duct dilation before ERP	No	4	4	0.000	1.000
Pancreatic duct stones	Yes	1	2	0.394	0.530
Pancreatic duct stones	No	6	5	0.394	0.530
AMY increases before ERP	Yes	5	4	0.289	0.591
AMY increases before ERP	No	2	3	0.289	0.591

Patient No.	Number of ERP treatments	Duration and course of ERP treatment	Follow-up time (month)	Relapse or not	Time of recurrence after the last ERP (month)	Stent indwelling time (month)	BMI change（kg/m²）
A	1	2018.1 5Fr dilation catheter tip dilated anastomotic site	39.0	Yes	1.0	0	-1.81
B	2	2016.8 5Fr stent was inserted after 5Fr catheter dilation	20.2	Yes	1.2	15.7（5Fr）	-0.34
B	2	2017.11 Removal of pancreatic duct stent	20.2	Yes	1.2	15.7（5Fr）	-0.34
C	2	2019.6 7Fr stent was inserted after 5Fr catheter dilation	21.8	No	/	13.3（7Fr）	+3.90
C	2	2020.7 Removal of pancreatic duct stent	21.8	No	/	13.3（7Fr）	+3.90
D	2	2019.11 4 mm cylindrical balloon dilated anastomotic site, 5Fr stent was inserted	17.7	No	/	15.0（5Fr）+2.7（7Fr）	+0.32
D	2	2021.2 4 mm cylindrical balloon dilated anastomotic site, 7Fr stent was inserted	17.7	No	/	15.0（5Fr）+2.7（7Fr）	+0.32
E	2	2020.12 Anastomotic site could not be found	2.7	No	/	2.7（7Fr）	0
E	2	2021.1 Cannulation was successful with a combination of enteroscopy and EUS-PD, 7Fr dilation catheter dilated anastomotic site, and 7Fr stent was inserted until now	2.7	No	/	2.7（7Fr）	0
F	1	2016.3 7Fr stent was inserted after 7Fr catheter dilation until now	61.5	No	/	61.5（7Fr）	+6.76
G	3	2015.2 5Fr catheter dilated anastomotic site, 5Fr stent was inserted	75.1	No	/	29.8（5Fr）+25.5（7Fr）	+2.00
		2017.8 7Fr catheter dilated anastomotic site, 7Fr stent was inserted
		2019.8 Removal of pancreatic duct stent
H	2	2020.7 6 mm cylindrical balloon dilated anastomotic site, partial stone, 5Fr stent was inserted 2021.1 6 mm cylindrical balloon dilated anastomotic site + all stones extraction, 7Fr stent was inserted until now	9.0	No	/	6.0（5Fr） +3.0（7Fr）	+1.83