慢性胰腺炎（CP ）是一种持续进展的非自限性疾病，主要以炎性反应、纤维化、胰腺腺泡及胰岛细胞的缺失为特征。持久反复的疼痛是CP患者最突出的临床表现，减轻疼痛、提高生活质量仍是临床医生所面临的巨大挑战。目前临床上尚无根治性治疗手段，治疗目标往往围绕缓解疼痛来进行，主要治疗手段包括内科药物治疗、内镜治疗及手术治疗。此文就CP疼痛的治疗进展作一综述。

胆管癌（cholangiocarcinoma，CCA）指起源于胆管上皮的恶性肿瘤，可分为肝内胆管癌（intrahepatic cholangiocarcino-ma，ICCA）和肝外胆管癌（extrahepatic cholangiocarcinoma， ECCA）。其中，ECCA 包括左、右肝管、肝总管及胆总管部位发生的肿瘤，约占 CCA 的90％［1］。与大多数肿瘤相似，早期CCA 几乎无症状或体征，患者就诊时多为中晚期阶段，只有20％～30％的患者能够获得完全切除（R0切除），而不能进行手术治疗患者的中位生存期仅为5～9个月［2］。因此，如何尽早发现和诊断 CCA 并给予最佳治疗方案是我们面临的巨大挑战。近年来，内镜技术迅猛发展，ERCP 直视下活检结合分子生物学诊断技术、腔内超声技术、窄带成像技术、胆道子母镜检查、共聚焦内镜、色素荧光内镜等技术逐步应用于临床，在 ECCA 的诊断中日趋重要。在此，本文就国内外关于 ECCA 内镜诊断的最新进展进行综述。

Oddi括约肌功能障碍（SOD）是指Oddi括约肌（SO）收缩异常引起的一系列临床综合征，其治疗主要包括药物治疗、内镜治疗和外科手术治疗三种手段。少数患者可通过药物治疗缓解症状，更多的患者依靠内镜治疗，尚有部分患者需通过括约肌成形术等外科手术方法才能达到治疗目的。

本文就常规超声、超声造影、超声内镜及弹性成像等多种超声技术,以及术中超声及腹腔镜超声在胰腺癌诊断中的应用进展做一综述,并对其各自优劣势进行阐述.

Objective To evaluate the efficacy and safety of endoscopic retrograde cholangiopancre-atography (ERCP)by using a duodenoscope in patients with prior Billroth Ⅱ gastrectomy.Methods Data of 98 patients(including 7 who underwent Billroth Ⅱand Braun)with prior Billroth Ⅱ gastrectomy who un-derwent ERCP from January 2008 to May 2014 at Endoscopy Center of Ruijin Hospital were retrospectively studied.Results A total of 98 patients accepted 111 ERCP procedures,the overall success rate was 75.7%(84 /111).The success rate of accessing Vater′s papilla was 82.0%(91 /111)and the selective can-nulations success rate was 92.3%(84 /91).In the cases of successful access,therapeutic procedures were achieved in 100.0%(84 /84)of all patients.The overall rate of complications was 4.5%(5 /111),with mild post-procedure pancreatitis occurring in 3 cases,cholangitis in 2 cases,respectively.Conclusion ERCP u-sing a duodenoscope can be safely and effectively performed in patients with prior Billroth Ⅱ gastrectomy with high cannulation and treatment success rates.

Objective To evaluate the indications,efficacy and safety of ERCP for nonagenarians and centenarians patients.Methods Data of nonagenarian or centenarian patients who went through ERCP in our hospital between January 1 st,2001 and March 31st,2014 were retrospectively analyzed.Their clinical characteristics,procedures of ERCP and complications after ERCP were also analyzed.Results A total of 97 nonagenarian or centenarian patients underwent 113 ERCP procedures,the success rate of cannulation was 96.5％,and the final success rate was 92.0％.Of the 97 patients,74 were diagnosed as having extrahepatic bile duct stones and/or bile duct infection,18 malignant obstructive jaundice,and 5 other benign pancreaticobiliary diseases.The overall ERCP related complication rate was 11.5％,mortality being 3.1％.Other complications were mild or moderate,and patients could recover in several days.Conclusion ERCP is both effective and safe for nonagenarian or centenarian patients,however,more research with larger samples is still needed to support it.