内镜技术在肝外胆汁淤积性黄疸患者中的临床应用分析  

The clinical analysis on endoscope technique applicated for patients suffering from extrahepatic cholestatic jaundice

作　　者：张振中[1] 陈伍霞[1] 孙源源[1] 

机构地区：[1]南通市第三人民医院消化科,江苏南通226006

出　　处：《临床肝胆病杂志》2011年第9期918-921,共4页Journal of Clinical Hepatology

摘　　要：目的探讨经内镜逆行胰胆管造影(ERCP)胆管引流术对各种良恶性肝外胆汁淤积疾病的治疗效果。方法 139例肝外胆汁淤积患者先行ERCP检查,确定胆管狭窄梗阻病变部位和性质后,再选择以下治疗方法:内镜下乳头肌切开术(EST)、内镜下乳头括约肌气囊扩张术(EPBD)、内镜下鼻胆管引流(ENBD)、内镜下塑料胆道支架引流(ERBD)和内镜下金属胆道支架引流(EBMSD)。结果针对良性胆管狭窄行EST、EPBD、ENBD及ERBD共59例,主要见于胆总管结石、胆管炎、胆管乳头狭窄和肝移植术后胆道并发症;针对恶性胆管狭窄行ENBD 14例,ERBD 6例,行EBMSD 26例,主要见于胰头癌、胆管癌、壶腹癌、原发性肝癌及肝门与肝内转移压迫胆管,所有病例均在引流后TB il及DB il等肝功能指标明显下降;术后两组分别有10、6例出现血淀粉酶一过性增高。结论经内镜下ERCP治疗技术在肝外胆汁淤积患者中的应用是安全有效的,对各种良恶性病变引起的胆管狭窄梗阻起了一定的治疗作用。Objective To investigate the therapeutical effections of ERCP（endoscopic retrograde cholangiopancreatography） and biliary drainage on treating a veriety of beingn and malignant diseases with extrahepatic cholestatic stagnation.Methods 139 patients with extrahepatic cholestatic stagnation could choose the following remedial measures： EST（endoscopic sphincterotomy）,EPBD（endoscopic papillar bladder dilatation）,ENBD（endoscopic nosobiliary drainage）,ERBD（endoscopic retrograde biliary drainage）,EBMSD（endoscopic biliary mental stent drainage）when they were ascertained the location and character of bile duct＇s stericture and obstruction by ERCP examination.Results 59 patients who having beingn bile duct stricture disease were treated by using EST,EPBD,ENBD and ERBD.These diseases were majorly involved in the common bile duct stone,cholangitis,bile duct and papillary stricture,and biliary complication after liver transplantation.Among the malignant bile duct stricture patients,14 of them were given ENBD treatment,6 of them were given ERBD treatment,the others were given EBMSD treatment,these diseases were mostly involved in pancreatic head carcinoma,cholangiocarcinoma,and ampullary carcinoma.Primary carcinoma of liver together with intrahepatic and hilar metastasis which oppessing bile duct was also included.All patients＇ liver functional indexes were declined obviously such as total bilirubin,direct bilirubin,and so on;After the twogroups were 10,6 patients had a transient serum amylase increased.Conclusion For patients with extrahepatic cholestatic stagnation,the theraputical technique by ERCP isn＇t only safe and effective,but also plays positive actions in a certain degree on treating stericture and obstruction of bile duct resulted from benign and malignant abnormality.

关 键 词：胆汁淤积 肝外 黄疸 阻塞性 内窥镜检查 引流术 

分 类 号：R657.4[医药卫生—外科学]