内镜逆行胰胆管造影联合胆道镜诊断胆管导管内乳头状黏液性肿瘤1例并文献复习

Endoscopic Retrograde Cholangiopancreatography Combined with Cholangioscopy in the Diagnosis of Intraductal Papillary Mucinous Neoplasm of the Bile Duct: A Case Report and Literature Review

摘要: 胆管导管内乳头状黏液性肿瘤是一类起源于胆管黏膜上皮的肿瘤，临床罕见。其临床表现、实验室检查及常见的影像学检查不具备特异性，给疾病诊断带来了挑战。本文介绍了一例临床表现为胆管炎，常规影像学检查见胆管狭窄及扩张的患者，该患者常规检查均未明确诊断，经内镜逆行胰胆管造影联合胆道镜可见黏液自十二指肠乳头溢出，直视下获取病理组织，最终明确诊断为胆管导管内乳头状黏液性肿瘤。这提示我们内镜逆行胰胆管造影联合胆道镜的价值，为临床诊疗提供一定的参考。

Abstract: Intraductal papillary mucinous neoplasm is a rare type of tumor originating from the epithelium of the bile duct. Its clinical manifestation, laboratory examination and common imaging examination do not have specificity, which result in a challenge to the diagnosis of the disease. This paper reports on a case of a patient with clinical manifestations of cholangitis and conventional imaging studies revealing biliary strictures and dilatations. The patient’s routine examinations failed to establish a definitive diagnosis. However, we employed endoscopic retrograde cholangiopancreatography (ERCP) combined with cholangioscopy to observe mucus spilling from the duodenal papilla and obtained pathological tissue under direct vision. The final diagnosis was intraductal papillary mucinous neoplasm of the bile duct. It implies that ERCP combined with choledochoscopy is valuable for clinical diagnosis and treatment.