摘要
胆胰管汇合部疾病是胆胰系统炎症、结石、肿瘤等良恶性疾病的重要诱因,经内镜逆行胰胆管造影术(ERCP)则是治疗胆胰管汇合部疾病及胆胰系统疾病的重要方法,但是Oddi括约肌(SO)过度损伤会破坏胆道密闭性,发生反流性胆管炎、结石、肿瘤等并发症。本文在精准外科理念指导下,基于SO解剖及生理功能,阐述胆胰管汇合部疾病的精准分类、诊断和治疗。通过采取病因祛除、损伤控制和器官保护的精准外科策略,不仅能有效解除胆胰管流出道梗阻,促进胆胰疾病的快速康复并降低术后并发症的发生率,还能最大程度保留SO功能,减少术后远期并发症的发生,使医患双方获益最大化。
The confluence diseases of pancreaticobiliary ducts are important causes of benign and malignant diseases such as inflammation,stones,and tumors of the biliary and pancreatic systems.Endoscopic retrograde cholangiopancreatography(ERCP)has played an important role in the diagnosis and treatment of the confluence diseases of pancreaticobiliary ducts and the biliary and pancreatic systems diseases.However,excessive damage to the sphincter of Oddi(SO)can break the biliary tightness,leading to complications such as reflux cholangitis,stones,and tumors.Under the guidance of the concept of precision surgery,this article elaborates on the precise classification,diagnosis,treatment,and strategies of the confluence diseases of pancreaticobiliary ducts based on the anatomy and physiological function of the SO.By adopting the precise surgical strategies of cause elimination,damage control,and organ protection,which can not only effectively alleviate the obstruction of the biliary and pancreatic outflow tract,promote the rapid recovery of biliary and pancreatic diseases,reduce the incidence of postoperative complications,but also maximize the protection of the SO function,reduce the occurrence of long-term postoperative complications,and bring maximum benefits to doctors and patients.
作者
杨玉龙
董家鸿
Yang Yulong;Dong Jiahong(Center for Gallstone Disease,Dongfang Hospital,Tongji University,Shanghai 200120,China;Hepatopancreatobiliary Center,Beijing Tsinghua Changgung Hospital,Tsinghua University,Beijing 102218,China)
出处
《中华医学杂志》
北大核心
2025年第34期2911-2917,共7页
National Medical Journal of China
基金
上海市浦东新区卫生系统重点专科建设项目(PWZzk2022-17)
上海市东方医院临床研究项目(DFLC2022019)
上海市东方医院重点学科基金项目-胆石病科(2024-DFZD-005DS)。
关键词
奥狄括约肌
胆胰管汇合部疾病
精准外科
胰胆反流
内镜下十二指肠乳头括约肌切开术
内镜下胰胆分流术
Sphincter of Oddi
Confluence disease of pancreaticobiliary ducts
Precision surgery
Pancreaticobiliary reflux
Endoscopic papillary sphincterotomy
Endoscopic pancreaticobiliary separation
