胰十二指肠切除术后行内镜逆行胰胆管造影术诊治的回顾性分析

Retrospective analysis of endoscopic retrograde cholangiopancreatography after pancreaticoduodenectomy

摘要:

目的 评估胰十二指肠切除术后行内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography， ERCP）的有效性和安全性及内镜选择策略。方法 回顾性分析2013年1月—2021年12月在空军军医大学第一附属医院消化内镜中心接受ERCP诊治的34例胰十二指肠切除术后患者的临床资料，分析插镜成功率、诊断成功率、治疗成功率、ERCP成功率和不良事件的发生情况。结果 34例患者接受了50例次ERCP诊治。胰十二指肠切除术后ERCP的插镜成功率、诊断成功率、治疗成功率和ERCP成功率分别为92.0%（46/50）、93.5%（43/46）、88.4%（38/43）和76.0%（38/50）。结肠镜和气囊辅助式小肠镜辅助ERCP的成功率分别为76.0%（19/25）和75.0%（18/24）；共有3例不良事件，1例患者术中发生胆肠吻合口黏膜撕裂，1例患者术中发生心跳呼吸骤停，1例患者术后发生胆管炎。结论 胰十二指肠切除术后行ERCP总体是有效和安全的。胰十二指肠切除术后使用结肠镜和气囊辅助式小肠镜辅助ERCP具有相似的成功率。

Abstract:

Objective To evaluate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) after pancreaticoduodenectomy and endoscopic selection strategies. Methods Clinical data of 34 patients treated with ERCP after pancreaticoduodenectomy at the Endoscopic Center of the First Affiliated Hospital of Air Force Medical University from January 2013 to December 2021 were retrospectively analyzed. The success rates of endoscopic insertion, diagnosis, treatment and ERCP, and the incidence of adverse events were analyzed. Results Fifty ERCP treatments were performed in 34 patients. The success rates of endoscopic insertion, diagnosis, treatment, and ERCP after pancreaticoduodenectomy were 92.0% (46/50), 93.5% (43/46), 88.4% (38/43) and 76.0% (38/50), respectively. The success rates of ERCP assisted with colonoscope and balloon-assisted enterosocpe were 76.0% (19/25) and 75.0% (18/24), respectively. There were 3 adverse events, including 1 case of anastomotic mucosa tear during surgery, 1 case of cardiopulmonary arrest and 1 case of postoperative cholangitis. Conclusion ERCP is effective and safe after pancreaticoduodenectomy in general. ERCP assisted with colonoscope and balloon-assisted colonoscope shows similar success rate after pancreaticoduodenectomy.