内镜介入治疗对慢性胰腺炎临床疗效

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1、内镜介入治疗对慢性胰腺炎临床疗效【摘要】目的探讨内镜介入治疗对慢性胰腺炎的临床疗效。方法29例慢性胰腺炎患者行内镜介入治疗。其中,21例胰管扩张者行胰管括约肌切开(EPS);19例胰管有明显狭窄者置入胰管内支架(ERPD);12例副胰管扩张者则行副乳头括约肌切开并行副胰管内支架置入;8例胰管结石者先行EPS后用探条扩张狭窄段,再用网篮或气囊取石,若取石困难则做ERPD;平均每个月电话随访一次,必要时复查逆行胰胆管造影(ERCP)。结果内镜介入治疗成功率86.21%(25/29)。术后1、6、12个月时腹痛完全缓解率分别为75.86%、65.52%、68.97%;消瘦、脂肪泻等症状均不同程度得

2、到改善,2例患者分别于术后第5个月及第11个月出现支架阻塞予更换支架治疗。术后并发一过性高淀粉酶血症7例,急性胰腺炎2例,出血2例,无穿孔发生,无中转手术或死亡。结论内镜介入治疗具有安全、有效、创伤小的优点,在治疗慢性胰腺炎方面应有较好的应用前景。【关键词】慢性胰腺炎;内镜介入治疗;逆行胰胆管造影(ERCP);胰管内支架(ERPD)Theclinicaleffectsofinterventionalendoscopictherapyonthetreatmentofchronicpancreatitis10WEIJin-qi,ZHOUXiao-jun,BIANZhuang.Department

3、ofGastroenterology,the5thaffiliatedhospitalofSunYet-Senuniversity,Guangdong519000,China【Abstract】ObjectiveTodiscusstheclinicaleffectsofinterventionalendoscopictherapyonthetreatmentofChronicPancreatitis.MethodsAtotalof29patientswithchronicpancreatitisweretreatedwithinterventionalendoscopictherapy.Am

4、ongthem,21patientsunderwentEPS.19patientsweretreatedwithERPD;12patientsunderwentminorpapillasphincterotomyandendoscopicstenting;8patientswithstoneswereremovedusingbasketorballoon.Afterwards,ERPDwasperformedifnecessary.Thesepatientswerefollowedupevery1months,ERCPwereusedifnecessary.ResultsThesuccess

5、fulrateofinterventionalendoscopictherapywas86.21%,completeremissionrateofabdominalpainwas75.86%,65.52%,68.97%atthe1,6,12month,clinicalsymptomssuchasmarasmusandfattydiarrheaweremarkedlyimproved.Thestentwasreplacedin2caseafter5,11month10becauseofobstruction.Afterthetreatment,7patientsdevelopedtransie

6、nthyperamylasemia,2hadacutepancreatitis,2hadhemorrhage.Noperforation,conversiontoanopensurgery,ordeathoccurredinthisseries.ConclusionInterventionalendoscopictherapyissafe,effective,minimallyinvasive,andwillbethefirstchoiceforthetreatmentofthechronicpancreatitis.【Keywords】Chronicpancreatitis;interve

7、ntionalendoscopictherapy;Retrogradecholangiopancreatography,ERCP;ERPD慢性胰腺炎(chronicpancreatitis,CP)是由于各种不同的原因造成的胰腺组织和功能的持续、永久性损害,造成不同程度的腺泡萎缩、腺管变形、纤维化及钙化,并最终导致胰腺内、外分泌功能障碍,从而出现相应的临床症状[1]。传统的内科保守治疗效果差,外科手术创伤较大。