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中华腔镜外科杂志(电子版) ›› 2026, Vol. 19 ›› Issue (04) : 242 -247. doi: 10.3877/cma.j.issn.1674-6899.2026.04.009

综述

局部胰管狭窄的内镜诊治策略研究进展
盛亮1,2,3, 李佳1, 于娜1, 张磊1,2,3,†()   
  1. 1730000 兰州大学第一临床医学院
    2兰州大学第一医院普外科
    3730000 兰州大学第一医院,甘肃省生物治疗与再生医学重点实验室/普通外科国家临床重点专科/肃省普通外科临床医学研究中心
  • 收稿日期:2026-07-05 出版日期:2026-08-30
  • 通信作者: 张磊
  • 基金资助:
    甘肃省科技重大专项项目(24ZDFA005); 甘肃省卫生行业科研计划项目优秀青年人才和骨干人才科研专项(GSWSQN2023-01); 兰州大学第一医院院内基金项目(ldyyn2025-72)

Endoscopic management of local pancreatic duct stricture: recent advances

Liang Sheng1,2,3, Jia Li1, Na Yu1, Lei Zhang1,2,3,†()   

  1. 1The First Clinical Medical College of Lanzhou University, 730000, China
    2Department of General Surgery, The First Hospital of Lanzhou University, 730000, China
    3Key Laboratory of Biotherapy and Regenerative Medicine of Gansu Province, The First Hospital of Lanzhou University, 730000, China/National Key Clinical Specialty of General Surgery/Gansu Provincial Clinical Medical Research Center for General Surgery
  • Received:2026-07-05 Published:2026-08-30
  • Corresponding author: Lei Zhang
引用本文:

盛亮, 李佳, 于娜, 张磊. 局部胰管狭窄的内镜诊治策略研究进展[J/OL]. 中华腔镜外科杂志(电子版), 2026, 19(04): 242-247.

Liang Sheng, Jia Li, Na Yu, Lei Zhang. Endoscopic management of local pancreatic duct stricture: recent advances[J/OL]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2026, 19(04): 242-247.

局部胰管狭窄(local pancreatic duct stricture,LPDS)指主胰管或分支胰管局限节段出现狭窄、截断或不规则变细,可伴上游胰管扩张、实质萎缩、胰液引流障碍、结石、胰漏或反复胰腺炎。LPDS可由慢性胰腺炎、胰管结石、术后吻合口狭窄、外伤或自身免疫性胰腺炎等良性病变引起,也可能是胰腺导管腺癌、高级别胰腺导管上皮内瘤变(pancreatic intraepithelial neoplasia,PanIN)、胰腺导管内乳头状黏液性肿瘤(intraductal papillary mucinous neoplasm,IPMN)或其他肿瘤的早期线索。近年来,内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)、超声内镜(endoscopic ultrasound,EUS)、经口胰管镜(per-oral pancreatoscopy,POPS)、EUS引导下胰管引流(EUS-guided pancreatic duct drainage,EUS-PD)、序贯胰液细胞学、EUS引导下细针穿刺抽吸/活检(endoscopic ultrasound-guided fine-needle aspiration/biopsy,EUS-FNA/FNB)和胰管支架技术不断发展,使LPDS诊断从单纯形态判断转向"影像-内镜-组织-分子"整合评估,治疗从单纯扩张和支架置入转向按病因、解剖条件和风险分层的个体化策略。本文围绕LPDS概念、病因、内镜诊断路径、良恶性狭窄治疗、难治性狭窄处理、并发症防治及前沿进展进行综述,旨在为临床建立规范化、可操作的内镜诊治流程提供参考。

Local pancreatic duct stricture (LPDS) is defined as focal narrowing, cutoff or irregular tapering of the main pancreatic duct or branch pancreatic ducts, which may be accompanied by upstream pancreatic duct dilatation, parenchymal atrophy, impaired pancreatic juice drainage, calculi, pancreatic fistula or recurrent pancreatitis. LPDS can result from benign conditions including chronic pancreatitis, pancreatic duct stones, postoperative anastomotic stricture, trauma and autoimmune pancreatitis; it may also serve as an early indicator of pancreatic ductal adenocarcinoma, high-grade pancreatic intraepithelial neoplasia (PanIN), intraductal papillary mucinous neoplasm (IPMN) or other neoplasms. In recent years, advances in endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasonography (EUS), peroral pancreatoscopy (POPS), EUS-guided pancreatic duct drainage (EUS-PD), sequential pancreatic juice cytology, EUS-guided fine-needle aspiration/biopsy (EUS-FNA/FNB) and pancreatic duct stenting have transformed the diagnosis of LPDS from simple morphological assessment to an integrated "imaging-endoscopy-histology-molecular" evaluation. Correspondingly, treatment has evolved from straightforward dilation and stent placement to individualized strategies stratified by etiology, anatomical features and risk profiles. This review summarizes the definition, etiologies, endoscopic diagnostic algorithms, management of benign and malignant strictures, interventions for refractory strictures, prevention and treatment of complications, and cutting-edge advances of LPDS, aiming to provide evidence for establishing standardized and practical endoscopic diagnosis and treatment workflows in clinical practice.

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