中国实用外科杂志

中国实用外科杂志

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ERCP在医源性胆管损伤中的治疗价值（附117例报告）

张    辉，周文策，李    汛，孟文勃，张    磊，苗    龙，王正峰，朱克祥   

  1. 兰州大学第一医院普外二科  兰州大学第一医院ERCP诊疗中心 甘肃省肝胆胰外科研究所 甘肃省细胞治疗与再生医学重点实验室，甘肃兰州 730000
  • 出版日期:2017-11-01 发布日期:2017-11-01

  • Online:2017-11-01 Published:2017-11-01

摘要：

目的    探讨内镜逆行胰胆管造影（ERCP）技术在医源性胆管损伤中的应用价值。方法    回顾性分析2007年1月至2016年8月兰州大学第一医院普外二科收治的医源性胆管损伤并行ERCP治疗的病人117例临床资料，分析ERCP治疗不同Strasberg分型胆管损伤的临床效果。结果    117例胆管损伤病人均实施ERCP治疗，其中Strasberg分型A型 56例，C型 10例，D型 17例，E型 34例（E1 型13例、E2型10例、E3型5例、E4型6例），87例（74.4%，87/117）病人行ERCP治疗效果良好。ERCP治疗方案为鼻胆管引流、胆道塑料支架或金属覆膜支架联合应用。术后随访1年，A型有效率为100%（56/56），C型有效率为33.3%（3/10），D型有效率94.1%（16/17），E型总有效率为35.3%（12/34）。30例病人内镜治疗未获成功，经经皮肝穿刺胆管引流（PTCD）后转外科手术治疗。87例病人成功实施ERCP病例中，7例术后发生急性胆管炎，6例发生急性胰腺炎，均经保守治疗痊愈，无其他并发症发生。结论    ERCP对胆漏型胆管损伤中Strasberg分型A、D型病人疗效好，对于合并副右肝管损伤的C型病人疗效欠佳；而对于部分StrasbergE3、E4型的高位狭窄及少数E1、E2型严重狭窄的病人，ERCP疗效有待提高。

关键词: 内镜逆行胰胆管造影, 胆管损伤, 引流术, 支架

Abstract:

Treatment value of ERCP in bile duct injury after operation: A report of 117 cases        ZHANG Hui, ZHOU Wen-ce, LI Xun, et al. Second Department of General Surgery, the First Hospital of Lanzhou University; Center of ERCP Diagnosis and Treatment in the First Hospital of Lanzhou University, Hepatobiliary and Pancreatic Surgery Research Institute of Gansu Province; Key Laboratory of Cell Therapy and Regenerative Medicine of Gansu Province, Lanzhou 730000, China
Corresponding author: ZHOU Wen-ce, E-mail:zhouwc@lzu.edu.cn
Abstract    Objective    To investigate the application value of ERCP technique in bile duct injury   Methods    The clinical data of 117 cases of bile duct injury treated with ERCP in the Second Department of General Surgery, the First Hospital of Lanzhou University from January 2007 to August 2016 were analyzed retrospectively. The effect of ERCP in the treatment of different Strasberg types of bile duct injury was analyzed retrospectively. Results    All the 117 cases were treated with ERCP, of which type Strasberg-A 56 cases, type C 10 cases, type D 17 cases and type E 34 cases (E1 13 cases, E2 10 cases, E3 5 cases and E4 6 cases) repectively.Eighty-seven cases of ERCP had good curative effect; successful rate of ERCP surgery was 74.4% (87/117). ERCP treatment was nasal biliary drainage combined with plastic biliary stent or metal stent. The postoperative follow-up lasted for 1 years. The effective rate of Strasberg-A,-C,-D,-E type was 100% (56/ 56),33.3% (3/10), 94.1% (16/17) and, 35.3% (12/34) repectively. A total of 30 cases were treated with PTCD drainage and open operations after the endoscopic treatment failure. Among the 87 cases in which the ERCP were successfully implemented, 11 cases had postoperative acute cholangitis and 8 cases had acute pancreatitis after ERCP; all of which were cured by conservative treatment; no other complications occurred. Conclusion    ERCP has a good effect on biliary tract injury with Strasberg-A .-D type and is less effective in Strasberg-C type combined with right hepatic duct injury. For some Strasberg- E3,-E4 type stenosis and a few Strasberg-E1,-E2 type severe stenosis, ERCP efficacy need to be improved.

Key words: endoscopic retrograde cholangiopancreatography , bile duct injury, drainage, stent