【作者】 郑明伟；

【导师】 秦鸣放；

【作者基本信息】 天津医科大学 ， 中西医结合临床， 2008， 硕士

【摘要】 背景:CP是胰腺的一种慢性、进行性、炎症性疾病,其治疗是目前内科、外科均为棘手的难题。随着内镜治疗技术的不断发展,内镜治疗以其操作简便、创伤小、并发症少、疗效好的特点,已被广泛接受为CP的首选方法。目的:探讨CP的内镜诊断的临床价值,评价内镜治疗CP的临床疗效,评价其安全性。方法:选取2004年1月1日至2008年5月天津市南开医院收治的32例住院并行内镜治疗的CP患者进行回顾分析,分析B超、CT、MRCP和ERCP等影像学检查的优势与缺点,讨论CP的最佳诊断方法;采取门诊和电话定期随访内镜治疗术后的临床疗效,观察治疗前后患者腹痛症状和BMI的变化。结果:共纳入符合CP诊断标准并进行内镜下治疗的患者32例。32例患者均行内镜治疗,操作成功率为90.3%(29/32)。其中单纯胰管括约肌切开8例(27.6%),单纯行胰头部胰管气囊括张3例(9.4%);胰管取石7例(24.1%),13例(44.8%)放置主胰管支架,1例(3.4%)放置副胰管支架,经胃壁假性囊肿置管引流2例(17.2%),3例(10.3%)患者内镜治疗未成功。B超、CT、MRCP和ERCP的诊断准确率分别为65.6%(21/32),73.1%(19/26),81.8%(18/22)和93.1%(27/29)。29例患者随访时间1个月-45个月,其腹痛症状均有不同程度缓解(P＜0.05)。1年后随访23例(82.8%)患者腹痛症状缓解,其中有11例(37.9%)腹痛缓解持续时间长达2年。所有患者体重有一定程度增加(P＜0.05),BMI治疗前为22.09±3.78,治疗后随访1年BMI为25.03±3.42。14例放置胰管支架的患者中,3例患者因腹痛症状无明显改善在术后18-34天支架提前取出,行外科手术治疗。其余11例患者中6例支架在9个月后取出(9个月内分别行1—2次支架置换),3例支架长期留置超过12个月未进行更换,随访无腹痛症状复发,2例支架置入时问小于3个月。术后6个月内支架脱落1例,支架移位1例。32例患者共行内镜治疗43例次,术后出现急性胰腺炎2例,一过性高淀粉酶血症7例,恶心呕吐症状5例;无出血、感染、穿孔及急性胆管炎等并发症。结论:1内镜ERCP诊断CP准确率高,敏感性强,是各项影像学检查中诊断CP的金标准。ERCP与B超及CT联合应用可提高CP诊断的准确率,是我们推荐的最佳方法。2内镜治疗CP创伤小,安全性高,可重复操作性强,能有效缓解患者的腹痛症状,术后患者体重均有不同程度的增加,可作为治疗CP的首选方法。更多还原

【Abstract】 Backgroud:Chronic pancreatitis(CP)is a chronic,progressive and inflammatory disease.It is quite difficult for both medicine and surgery to treat it. But with the development of endoscopy technique,most of patients with CP accept endoscopic treatment as their first choice for its convenient operation,lower complications and satisfied outcome.Objective:To investigate the clinical value of endoscopic diagnosis for CP,to evaluate the clinical effect and security of endoscopic treatment for CP.Method:Select 32 hospitalized patients of TianJin Nankai hospital between 2004.1 and 2008.5,all of whom received endoscopic treatment.Analyze the results of Ultrasound,Computed Tomography(CT),Magnetic Resonance Cholangiopancreatography(MRCP)and endoscopic retrograde cholangiopancreatography(ERCP)diagnose CP,to establish the best method for diagnosing CP;follow up their clinical therapeutic effect after endoscopic treatment using telephone or clinic service by observe the BMI and abdominal pain changes after endoscopic treatment.Result:32 patients who consistented with CP diagnostic criteria were selected.All of them received endoscopic treatment,performance achievement ratio 90.3%(29/32).8 patients received endoscopic pancreatic sphincterotomy(EPS), 3(9.4%)dilated pancreatic duct by the balloon;7(24.1%)had the pancreatic stone extracted with endoscopy,13(44.8%)l treated with main pancreatic duct stent,and 1 (3.4%)treated with accessory pancreatic duct stent,5(17.2%)received pseudocyst draining through gastric wall,3(10.3%)endoscopic treatment unsuccessed.The diagnosis accuracy rate of ultrasound,CT,MRCP and ERCP were 65.6%(21/32), 73.1%(19/26),81.8%(18/22)和93.1%(27/29)respectively.29 patients were followed up for 1-45 months,their abdominal pain significantly relieved(P＜0.05).The abdominal pain of 24(82.8%)patients relieved when they were followed up 2 weeks later,while there were 11 patients whose abdominal pain relieved up to 2 years.The body weight of the patients after treatment was significantly increased(P＜0.05),and their body weight averagely increased 2-10 Kg after treatment.The patients’BMI before treatment was22.09±3.78,and 25.03±3.42 after treatment.3 of 14 patients who received pancreatic duct stand took out of the stents18-34 days after the operation,because there was no obviously improvement of abdominal pain,and then received the surgical intervention.For another 11patients,6 took out of their stents in 9 months later(exchanged the stents 1-2 times),3 took the stents for more than 12 months without exchanging while there was no abdominal pain recurred,2 took the stems less than 3 months.1 patient’s stent amotioed and 1 migrated within 6 months after operation.32 patients received therapeutic endoscopy 43 times,the post-operation complications are 2 patients had acute pancreatitis,7 had hyperamylasemia and 5 patients suffered nausea and vomiting.There were no haemorrhage,infection, perforation and acute cholangitis.Conclusion:1 Endoscopic diagnosis of CP has higher accuracy and sensitivity.It is the golden standard among the examinations.ERCP combined ultrasound and CT can improve the diagnosis accuracy,which is the best approach we suggest.2 Endoscopic treatment of CP can effectively relieve the abdominal pain and the patients’BMI would increase.The advantage of Endoscoy is minimally invasive, lower complications and satisfied outcome.It indicates that endoscopy is an effective therapeutic method for CP.更多还原