经ERCP置放支架治疗医源性胆管狭窄49例体会  

The experience of treatment of 49 cases of iatrogenic bile duct stenosis by stent installation with the help of endoscopic retrograde cholangiopancreatography

作　　者：孙权[1] 刘志苏[1] 徐旭东[1] 

机构地区：[1]武汉大学中南医院普外科,430071

出　　处：《腹部外科》2010年第4期224-226,共3页Journal of Abdominal Surgery

摘　　要：目的探讨经内镜逆行性胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)置放支架治疗医源性胆管狭窄的治疗效果。方法采用经ERCP置放支架治疗医源性胆管狭窄49例,分别在术后第1、4、7和11天检测病人肝功能的变化情况,采用流式细胞术计数血白细胞水平,观察病人住院时间、临床治愈率及术后第1、3、5年复发率。结果治愈42例,治愈率为85.7%。术后第1、4、7和11天,病人丙氨酸转氨酶(ALT)、总胆红素、凝血酶原时间和血白细胞水平均呈明显下降趋势。比较各项指标术后第1天与第7天的数值,差异均有统计学意义(P<0.05);第7与第11天比较,各项指标差异均无统计学意义(P>0.05)。病人术后1、3、5年复发率分别为8.2%、12.2%和20.4%,术后肝功能恢复时间为(14.5±1.9)d,住院时间为(9.8±1.3)d。对于直径>3mm和<3mm的胆管狭窄病人,术后肝功能恢复时间、住院时间及术后复发率差异均有统计学意义(P<0.05)。结论经ERCP置放支架治疗医源性胆管狭窄可以提高远期疗效,尤其对于直径>3mm的胆管狭窄,其机制可能与保留十二指肠乳头Oddi括约肌功能和结构的完整性有关。Objective To investigate the effectiveness of stent installation with the help of endoscopic retrograde cholangiopancreatography（ERCP） for iatrogenic bile duct stenosis. Methods Fortynine patients were treated by stent installation with the help of ERCP. Liver function（ALT, total bili- rubin, prothrombin time） was tested on the day 1,4,7 and 11 after treatment. Flow cytometry was used to count leukocytes. Hospital stay, clinical curative rate and recurrence rate were monitored. Results Forty-two patients were cured and the curative rate was 85. 7 %. The number of leukocytes,ALT level, total bilirubin and prothrombin were also significantly decreased. There were significant differences between the first day and the seventh day after operation（P〈0. （15）. However, there were no obvious differences between the seventh day and the eleventh day after operation（P〉0. 05）. The 1-,3- and 5- year recurrent rate after operation was 8. 2 %, 12. 2 % and 20. 4 % respectively. The restoration time of liver function was（14. 5 ± 1.9） days,the hospital stay was （9. 8 ± 1.3） days. There was significant difference in hospital stay, mean restoration time of liver function and recurrent rate after operation between the patients with the diameter beyond 3 ram and those with the diameter below 3 mm（P〈 0. 05）. Conclusion The stent installation with the help of ERCP was a good choice to improve the long-term curative effectiveness of iatrogenic bile duct stenosis, especially to bile duct stenosis in which the diameter was beyond 3 mm. As soon as mechanism was concerned, conserving the integrity of structure and function of Oddi sphincter perhaps played an important role.

关 键 词：胆管 狭窄 病理性 胰胆管造影术 内窥镜逆行 

分 类 号：R6[医药卫生—外科学]