内镜逆行胰胆管造影术后专利辅助胰管防止胰腺炎。

A patent accessory pancreatic duct prevents pancreatitis following endoscopic retrograde cholangiopancreatography.

机构信息

Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.

出版信息

Dig Surg. 2010;27(2):140-3. doi: 10.1159/000286962. Epub 2010 Jun 10.

PMID:20551660

Abstract

BACKGROUND/AIM: Pancreatitis is the most common and feared complication of endoscopic retrograde cholangiopancreatography (ERCP). We previously examined patency of the accessory pancreatic duct (APD) by dye injection endoscopic retrograde pancreatography (ERP). APD patency was found in 43% of 291 control cases who had no particular changes in the head of the pancreas compared to only 6% in patients with acute pancreatitis. APD patency was closely related with the shape of the terminal portion of the APD. This study aimed to clarify whether patency of the APD prevents post-ERCP pancreatitis.

METHODS

We examined retrospectively the terminal shape of the APD by ERP in 34 patients with post-ERCP pancreatitis. Based on these data, patency of the APD was estimated from its terminal shape in patients with post-ERCP pancreatitis.

RESULTS

The stick-type APD (p < 0.01), which indicated high patency, was less frequent, and the branch-type APD (p < 0.01) and halfway-type APD, or no APD (p < 0.01), which showed quite low patency, were more frequent in patients with post-ERCP pancreatitis compared with controls. Accordingly, the estimated patency of the APD in post-ERCP pancreatitis patients was only 16%, which was significantly lower than the 43% in controls. There was no significant relationship between the estimated APD patency and the severity of post-ERCP pancreatitis.

CONCLUSIONS

The estimated APD patency was significantly lower in patients with post-ERCP pancreatitis. A patent APD may function as a second drainage system to reduce the pressure in the main pancreatic duct and prevent post-ERCP pancreatitis.

摘要

背景/目的：胰腺炎是内镜逆行胰胆管造影（ERCP）最常见和最可怕的并发症。我们之前通过染料注射内镜逆行胰胆管造影（ERP）检查了副胰管（APD）的通畅性。与急性胰腺炎患者相比，在 291 例无胰腺头部特殊变化的对照病例中，有 43%的 APD 通畅，而在急性胰腺炎患者中仅为 6%。APD 通畅性与 APD 末端的形状密切相关。本研究旨在阐明 APD 的通畅性是否可以预防 ERCP 后胰腺炎。

方法

我们通过 ERP 回顾性检查了 34 例 ERCP 后胰腺炎患者的 APD 末端形状。根据这些数据，我们从 ERCP 后胰腺炎患者的 APD 末端形状估计 APD 的通畅性。

结果

通畅性高的棒状 APD（p < 0.01）较少，而分支状 APD（p < 0.01）和中途型 APD 或无 APD（p < 0.01）则较少，APD 通畅性较低，在 ERCP 后胰腺炎患者中比对照组更为常见。因此，ERCP 后胰腺炎患者的 APD 估计通畅率仅为 16%，明显低于对照组的 43%。APD 估计通畅率与 ERCP 后胰腺炎的严重程度之间无显著关系。