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预防性胰管支架置入防止ERCP所致胰腺炎：应用时机

Author
Stuart Sherman, MD
Section Editor
Douglas A Howell, MD, FASGE, FACG
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF
Translators
刘劲松, 主任医师，教授

引言

内镜下放置聚乙烯支架是一种治疗多种胆管良性和恶性疾病的成熟方法。虽然将相似的技术应用于胰腺还处于初步阶段，但这类应用也在逐步开展。目前胰管支架主要用于主要狭窄胰管的搭桥、梗阻性胰管结石的旁路术、胰腺假性囊肿的引流、胰管破裂的封闭、症状性十二指肠小乳头(即胰腺分裂)和/或大乳头(即Oddi括约肌功能障碍)括约肌狭窄的治疗、操作诱发胰腺炎的预防和作为括约肌切断术的引导(表 1)。

本专题将着重总结放置胰管支架预防内镜下逆行胰胆管造影(endoscopic retrograde cholangiopancreatography, ERCP)术后胰腺炎的适应证和效果。胰管支架放置及其并发症的概述见其他专题。 (参见“胰管支架置入术及其并发症概述”)

ERCP术后胰腺炎的危险因素

胰腺炎是诊断性和治疗性ERCP操作最常见的并发症，发生率为1%-15%。 (参见“内镜下逆行胰胆管造影：适应证、患者准备和并发症”)

在ERCP和内镜括约肌切开过程中胰腺可以发生多种类型的潜在损伤，包括机械性、化学性、流体静压、酶、微生物、过敏及热力性[1]，这些损伤机制可以独立或协同作用导致术后胰腺炎的发生。已发现了数例ERCP术后胰腺炎患者及操作相关危险因素，这部分内容见其他专题。 (参见“内镜下逆行胰胆管造影后胰腺炎”)

预防性支架

认识到ERCP术后胰腺炎的危险因素是评估一系列预防这种并发症的措施的理论依据。预防性胰管支架置入可能是一种可行的方法。

          

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Literature review current through: 2017-06 . | This topic last updated: 2016-08-10.
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