摘要
目的探讨治疗性内镜逆行性胰胆管造影术(ERCP)在胆胰疾病中的应用价值及其并发症的防治。方法回顾性分析上海中医药大学附属普陀医院2001年9月至2006年9月行治疗性ERCP的811例胆胰疾病患者的临床资料。结果562例胆总管结石患者中行乳头切开术(EST)474例,行乳头气囊扩张术(EPBD)88例,结石总清除率为95%;244例恶性胆道梗阻患者中183例行鼻胆管引流(ENBD),61例行胆道内支架引流术(ERBD);5例恶性胆胰管梗阻患者行胆胰管双支架引流术。行胆道内支架引流可使血清胆红素明显下降,胰管支架置入可使上腹部疼痛有一定程度减轻。并发症:乳头切开处出血13例(1.6%),均发生于EST术后;急性胰腺炎43例(5.3%),其中发生于EST术后32例,EPBD术后7例,ENBD术后2例,ERBD术后2例;EST术后发生急性胆囊炎4例(0.5%);全组死亡2例(0.2%)。结论应用十二指肠镜行治疗性ERCP去除胆管结石,控制胆道炎症,解除胆胰管恶性梗阻是一种理想的微创外科方法,熟练的技术与细致的围手术期处理是防治并发症关键。
Objective To investigate the value of therapeutic ERCP in the patients with pancreaticobiliary diseases and the methods to manage complications. Methods From September 2001 to September 2006,811 cases treated with sideviewing duodenoscope were analyzed retrospectively. Results 474 by EST and 88 EPBD, the rate of duct stone clearance was 93%. Besides,183 ENBD were successful before operation,61 patients with malignant biliary tract stent,5 patients with malignant biliary and pancreatic duct obstruction were placed with biliary tract and pancreatic stent, serum total bili- rubin and the upper abdominal pain were markedly decreased after the placement of biliary and pancreatic duct stent,The incidence of complications after therapentic ERCP were hemorrhage （ 13 cases, 1.6% ）, acute pancreatic （43 cases, 5.3% ） ,acute cholecysititis （4 cases,0. 5% ） ,deaths occurred in 2 patients （0. 4% ）. Conclusion Therapeutic ERCP is effective and minimally invasive treatment for common bile duce stone, cholangitis, malignant biliary and pancreatic ductodstructions,the consummate skill and intensive care during pieroperation are the keys to prevent and manger the complications of therapeutic ERCP.
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2007年第4期300-301,306,共3页
Chinese Journal of Practical Internal Medicine
