经口胆胰管镜联合内镜逆行胰胆管造影经十二指肠乳头胆囊息肉切除的疗效及安全性分析

陶丽莹; 王宏光; 郭庆梅; 郭享; 朴连玉; 杨沐雨; 于泳; 阮丽斌; 谷建彬; 陈思; 杜迎亭; 盖秀英; 郭思捷

doi:10.12449/JCH250318

经口胆胰管镜联合内镜逆行胰胆管造影经十二指肠乳头胆囊息肉切除的疗效及安全性分析

DOI: 10.12449/JCH250318

1.
吉林市人民医院消化内镜科，吉林吉林 132001
2.
吉林市人民医院科教科，吉林吉林 132001
3.
吉林市人民医院病理科，吉林吉林 132001

基金项目:

吉林市科技创新发展计划项目 (20230406148)

伦理学声明：本研究方案经由吉林市人民医院伦理委员会审批，批号：LS-2023-0016，所纳入患者均签署知情同意书。

利益冲突声明：本研究不存在任何利益冲突。

作者贡献声明：陶丽莹负责课题设计，收集数据，资料分析，撰写论文；王宏光负责审核论文；郭庆梅、郭享、朴连玉、杨沐雨、于泳、阮丽斌、谷建彬、陈思、盖秀英负责数据收集；杜迎亭、郭思捷负责资料分析。

详细信息

通信作者:
王宏光， wanghongguang1817@163.com （ORCID： 0000-0003-1100-9804）

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出版历程
- 收稿日期: 2024-08-16
- 录用日期: 2024-09-09
- 出版日期: 2025-03-25

Efficacy and safety of endoscopic retrograde cholangiopancreatography combined with oral cholangiopancreatography in the treatment of duodenal papilla cholecystectomy

1.
Department of Gastroenterology Jilin People’s Hospital，Jilin Jilin 132001，China
2.
Department of Science and Education Jilin People’s Hospital，Jilin Jilin 132001，China
3.
Department of Pathology Jilin People’s Hospital，Jilin Jilin 132001，China

Research funding:

Science, Technology and Innovation Development Project of Jilin City (20230406148)

More Information

Corresponding author: WANG Hongguang， wanghongguang1817@163.com （ORCID： 0000-0003-1100-9804）

摘要

摘要: 目的探讨通过内镜逆行胰胆管造影（ERCP）联合经口胆胰管镜行经十二指肠乳头胆囊息肉切除治疗的可行性和安全性。方法回顾性分析2022年5月—2024年6月于吉林市人民医院消化内镜中心采用ERCP联合经口胆胰管镜行经十二指肠乳头胆囊息肉切除的8例胆总管结石合并胆囊息肉患者的临床资料，收集手术成功率和胆囊息肉清除技术成功率，胆囊管超选方式、整体手术时间、胆囊息肉切除时间、手术并发症等指标。结果手术成功率及胆囊息肉切除技术成功率为100%，其中3例患者通过导丝引导直视进入胆囊，5例通过经口胆胰管镜直接进入胆囊；整体手术时间为（51.88±12.34）min，胆囊息肉切除时间为（23.13±10.94）min；胆囊息肉病变直径为2～8 mm；病理结果为3例炎性息肉，1例腺瘤性息肉，4例胆固醇性息肉；术中及术后无并发症，术后随访2～27个月，胆囊无息肉复发。结论经口胆胰管镜在内镜下经十二指肠乳头胆囊息肉切除的临床应用，技术上相对安全可行。
- 胆囊疾病 /
- 息肉 /
- 肝胰管壶腹 /
- 胰胆管造影术，内窥镜逆行 /
- 经口胆胰管镜
Abstract: Objective To investigate the feasibility and safety of endoscopic retrograde cholangiopancreatography （ERCP） combined with oral cholangiopancreatography in the treatment of major duodenal papilla gallbladder polyps. Methods A retrospective analysis was performed for the clinical data of eight patients with choledocholithiasis and gallbladder polyps who underwent ERCP and combined with oral cholangiopancreatography for major duodenal papilla cholecystectomy in Center of Digestive Endoscopy， Jilin People’s Hospital， from May 2022 to June 2024， and related data were collected， including the success rate of surgery， the technical success rate of gallbladder polyp removal， the superselective method of cystic duct， the time of operation， the time of gallbladder polyp removal， and surgical complications. Results Both the success rate of surgery and the technical success rate of gallbladder polyp removal reached 100%， and of all eight patients， three patients used guide wire to enter the gallbladder under direct view， while five patients received oral cholangiopancreatography to directly enter the gallbladder. The time of operation was 51.88±12.34 minutes， and the time of gallbladder polyp removal was 23.13±10.94 minutes. The diameter of gallbladder polyp was 2‍ ‍—‍ ‍8 mm， and pathological examination showed inflammatory polyps in three patients， adenomatous polyps in one patient， and cholesterol polyps in four patients. There were no complications during or after surgery. The patients were followed up for 2‍ ‍—‍ ‍27 months after surgery， and no recurrence of gallbladder polyp was observed. Conclusion Oral cholangiopancreatography is technically safe and feasible in endoscopic major duodenal papilla cholecystectomy.
- Gallbladder Diseases /
- Polyps /
- Ampulla of Vater /
- Cholangiopancreatography， Endoscopic Retrograde /
- Oral Cholangiopancreatography

HTML全文

注： a，超声内镜提示胆囊壁可见强回声光团，后不伴声影；b，经口胆胰管镜进入胆总管，直视观察胆囊管开口，在导丝引导下尝试进镜；c，胆囊颈部应用球囊扩张；d，扩张后的胆囊颈部，经口胆胰管镜直视通过；e，胆囊壁可见息肉样隆起；f，应用电圈套器尝试套取胆囊息肉；g，电圈套器套住息肉根部，电凝切除；h，切除后的创面电凝止血，电圈套器进行电凝止血，可以直视观察到该处创面电凝后发白的状态；i，胆道内留置塑料支架引流，乳头上方应用1枚钛夹夹闭（钛夹是为了预防穿孔和迟发性出血）。

图 1 经口胆胰管镜在内镜下经十二指肠乳头胆囊息肉切除的治疗过程

Figure 1. Endoscopic Major duodenal papilla cholecystectomy with oral cholangiopancreatography

下载: 全尺寸图片幻灯片

注： a，胆囊腺瘤性息肉；b，符合腺瘤性息肉（HE染色，×40）；c，胆固醇性息肉；d，符合胆固醇性息肉，部分上皮细胞不典型增生（HE染色，×40）；e，胆囊炎性息肉；f，可见慢性急性炎细胞浸润，部分血管内皮细胞增生（HE染色，×40）。

图 2 胆囊息肉内镜图像及病理

Figure 2. Endoscopic image and pathology of gallbladder polyp

下载: 全尺寸图片幻灯片

表 1 8例患者的一般资料及手术情况

Table 1. General information and surgical findings of eight patients

序号	性别	年龄（岁）	病变大小（mm）	进入胆囊的方式	手术时间（min）	胆囊息肉切除时间（min）	切胆囊息肉器械	并发症	术后病理	随访时间（月）
1	女	76	2	导丝引导	47	17	热活检	无	炎性息肉	27
2	男	76	3.6	导丝引导	45	12	热活检	无	炎性息肉	24
3	女	53	6	导丝引导	65	42	电圈套	无	腺瘤性息肉	22
4	男	56	2	直视	27	10	热活检	无	炎性息肉	14
5	女	61	8	直视	53	35	电圈套	高淀粉酶血症	胆固醇性息肉	12
6	男	76	5	直视	57	17	热活检	无	胆固醇性息肉	6
7	男	39	4	直视+扩张	70	20	热活检	无	胆固醇性息肉	4
8	男	63	5	直视	51	32	电圈套	无	胆固醇性息肉	2
注：手术时间指十二指肠镜进镜至退镜时间。

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