超声内镜下胆道引流治疗逆行胰胆管造影失败的恶性梗阻性黄疸  

Endoscopic ultrasound-guided biliary drainage for patients with malignant obstructive jaundice after failed endoscopic retrograde cholangiopancreatography

作　　者：黄平[1] 张筱凤[1] 张皞 范震[1] 吕文[1] 黄海涛[1] 楼颂梅[1] 王霞[1] 

机构地区：[1]浙江省杭州市第一人民医院消化内科,310006 [2]浙江省杭州市西溪医院,310023

出　　处：《中华肝胆外科杂志》2016年第7期464-467,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：杭州市科技发展计划项目（20140733Q11）

摘　　要：目的探讨超声内镜下胆道引流（EUS-BD）治疗逆行胰胆管造影（ERCP）失败的恶性梗阻性黄疸患者的疗效。方法33例恶性梗阻性黄疸患者在ERCP不成功后改为超声内镜下胆道引流，观察其操作成功率、术后1周及1个月肝功能指标恢复情况、并发症发生率、住院时间和患者生存期。结果33例患者中，31例超声内镜穿刺成功，经胃穿刺14例，经十二指肠穿刺17例，行对接技术者8例，成功率为93．9％。术后1周较术前、术后1个月较术后1周肝功能指标均有显著改善（P〈0．05）。术后并发出血2例、胆管炎1例，均经保守治疗后改善，并发症发生率为9．1％。患者平均住院时间为（21．5±4．7）d；平均生存期为238d。结论超声内镜下胆道引流创伤小、疗效好，可作为ERCP失败恶性梗阻性黄疸的首选治疗。Objective To study the efficacy of endoscopic ultrasound （EUS）-guided hiliary drain- age after failed ERCP in patients with malignant obstructive jaundice. Methods 33 patients with malignant obstructive jaundice underwent EUS-guided biliary drainage after unsuccessful ERCP. The operative success rate, recovery of liver function at 1 week and at 1 month after operation, complication rate, hospitalization stay and patients＇ survival were analyzed. Results Of 33 patients, a stent was successfully placed using endoscopic ultrasound guidance in 31 patients. These included transgastric puncture in 14 patients, transduo- denal puncture in 17, and by a rendezvous technique in 8. The operative success rate was 93.9%. There were significant differences in the liver function before 1 week or 1 month after the procedure （ P 〈 0.05 ）. Two patients who developed bleeding and 1 patient who developed cholangitis responded well to conservative treatment. The complication rate was 9.1%. The hospitalization stay was （21.5±4.7） d and the average survival was 238 d. Conclusion EUS-guided biliary drainage is recommended as a first line treatment after failed ERCP in patients with malignant obstructive jaundice.

关 键 词：恶性梗阻性黄疸 胆道引流 超声内镜 逆行胰胆管造影 

分 类 号：R657.4[医药卫生—外科学] R445.1[医药卫生—临床医学]