内镜技术在医源性胆道损伤治疗中的应用  

ENDOSCOPIC THERAPY IN THE MANAGEMENT OF IATROGENIC BILE DUCT INJURY

作　　者：姜立[1] 陈孝平[1] 

机构地区：[1]华中科技大学附属同济医院,武汉430030

出　　处：《肝胆外科杂志》2009年第1期22-26,共5页Journal of Hepatobiliary Surgery

基　　金：湖北省医学临床研究中心资助项目(2008-5)

摘　　要：目的探讨以内镜逆行胰胆管造影(ERCP)为基础的内镜技术在对医源性胆道损伤的诊断和治疗中的临床应用及治疗效果。方法分析了1992～2008年在我院内镜中心行ERCP检查的30名医源性胆道损伤病人的资料,选择有内镜治疗指征的24例进行乳头括约肌切开(EST),鼻胆管引流,塑料支架支撑等治疗。结果24例接受内镜治疗的病人中,有胆漏5例,胆管狭窄19例。5例胆漏病人接受鼻胆管引流或EST联合支架置入治疗,胆漏皆愈合,预后良好。19例胆管狭窄病例接受球囊扩张+支架支撑治疗,其中12例治疗11～19个月后狭窄消失,取出支架后平均随访2年内未再出现狭窄;另外7例疗效欠佳。结论对于胆道损伤的病人,合理的内镜治疗可以使得病人避免再次手术的痛苦。内镜治疗胆漏的效果优良。在胆管狭窄的病人,狭窄段的部位和长度对内镜治疗的结果有决定性的影响。Objective To evaluate the application and efficacy of therapeutic encoscopic retrograde cholangio-pancreatography upon bile duct injury. Methods Thirty patients with bile duct injury from January 1992 to December 2008 were managed by ERCP. 24 patients with indication of endoscopic therapy were treated by endoscopic sphincterectomy（ EST）, endoscopic nasobiliary drainage and plastic stent drainage. Results Our group that received endoscopic therapy consisted of 5 cases with bile leak and 19 cases with bile duct stricture. All the 5 cases with bile leak were treated with satisfactory outcome. Among the 19 patients with bile duct stricture, 12 cases finish their course of treatment ranging from 11 to 19months successfully,with no further stricture within 2 years＇ follow up. The other 7 cases presented poor outcome. Conclusion Endoscopic therapy could be viewed as alternative to surgical reconstruction for bile duct injury in selected patients. It＇ s role has been proved upon treatment for bile leak. As to the field of bile duct stricture,the feasibility and success of endoscopic therapy depend on the length and location of the stricture.

关 键 词：胆道损伤 内镜 治疗 临床 

分 类 号：R657.3[医药卫生—外科学]