内镜括约肌切开术是治疗与胰胆管合流异常相关的难治性胰腺炎的一种有用的术前处理方法。

Endoscopic sphincterotomy is a useful preoperative management for refractory pancreatitis associated with pancreaticobiliary maljunction.

作者信息

Terui Keita, Yoshida Hideo, Kouchi Katsunori, Hishiki Tomoro, Saito Takeshi, Mitsunaga Tetsuya, Takenouchi Ayako, Tsuyuguchi Toshio, Yamaguchi Taketo, Ohnuma Naomi

机构信息

Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8677, Japan.

出版信息

J Pediatr Surg. 2008 Mar;43(3):495-9. doi: 10.1016/j.jpedsurg.2007.10.071.

DOI:10.1016/j.jpedsurg.2007.10.071

PMID:18358288

Abstract

BACKGROUND

Pancreatitis associated with pancreaticobiliary maljunction (PBM) is commonly treated nonoperatively before surgery. It is, however, sometimes uncontrollable, and little has been reported about the management.

METHODS

Focusing on the preoperative management, we reviewed clinical courses of 4 PBM cases (ages 1 to 7 years old). Each had pancreatitis that was totally resistant to medical treatment and was applied endoscopic sphincterotomy (ES).

RESULTS

The first case underwent percutaneous transhepatic catheter drainage (PTCD) primarily. In spite of daily lavage using the drainage tube for a week, plugs located in the common channel were not removed, and clinical findings were not improved. Therefore, ES followed by removal of protein plugs was performed to improve pancreatitis dramatically. Through this experience, 3 subsequent cases with refractory pancreatitis all underwent successful ES primarily soon after the medical treatments turned out to be ineffective. In all 4 cases, protein plugs were impacted in common channels, and ES could successfully remove the plugs that were impossible to remove by using PTCD. Improved preoperative pancreaticobiliary decompression by ES shortens the duration of recalcitrant acute pancreatitis associated with PBM allowing for a subsequent safe operation.

CONCLUSIONS

Endoscopic sphincterotomy is one of the useful preoperative managements for refractory pancreatitis associated with PBM.

摘要

背景

胰胆管合流异常（PBM）相关的胰腺炎通常在手术前采用非手术治疗。然而，有时这种治疗难以控制，关于其治疗方法的报道较少。

方法

针对术前管理，我们回顾了4例PBM病例（年龄1至7岁）的临床病程。每例均患有对药物治疗完全抵抗的胰腺炎，并接受了内镜括约肌切开术（ES）。

结果

第一例主要先行经皮经肝胆管引流（PTCD）。尽管使用引流管每日冲洗一周，但位于共同通道的堵塞物未被清除，临床症状也未改善。因此，随后进行了ES并清除蛋白堵塞物，胰腺炎症状显著改善。基于这一经验，后续3例难治性胰腺炎病例在药物治疗无效后不久均首先成功进行了ES。在所有4例病例中，蛋白堵塞物均嵌顿在共同通道，ES成功清除了使用PTCD无法清除的堵塞物。ES改善术前胰胆管减压，缩短了与PBM相关的顽固性急性胰腺炎的病程，从而使后续手术得以安全进行。