急诊内镜下逆行胰胆管造影术治疗急性梗阻性胆管炎及胆源性胰腺炎疗效分析  

Emergency ERCP in the management of acute obstructive cholangitis and biliary pancreatitis

作　　者：刘梦园[1] 孙明军[1] 

机构地区：[1]中国医科大学附属第一医院内镜科,辽宁沈阳110001

出　　处：《临床军医杂志》2017年第5期504-507,共4页Clinical Journal of Medical Officers

摘　　要：目的探讨急诊内镜下逆行胰胆管造影术(ERCP)治疗急性胆管炎的时机、安全性和有效性。方法回顾性分析2014年9月至2016年12月确诊或疑诊急性胆管炎或胆源性胰腺炎的90例患者临床资料,分别于术前及术后3~10 d观察腹痛、发热、皮肤黄染等症状,比较血压、血常规、肝功、血淀粉酶及脂肪酶等指标,评价感染控制、梗阻性黄疸缓解情况以及疗效。结果 90例患者中,术中诊断胆总管结石78例(86.0%);Mirrizz综合征1例(1.0%);胆道、胰腺肿瘤5例(6.0%);胆管造影未见充盈缺损6例(7.0%)。急诊ERCP手术均成功行胆管引流,单纯行鼻胆管引流61例,塑料支架引流12例,金属支架引流1例,取石16例。90例患者,腹痛缓解率100%,感染缓解率90.7%,黄疸缓解率85.2%。治疗后痊愈出院76例(84.4%);好转9例(10.0%);病死5例(5.6%)。结论诊断中、重度急性梗阻性胆管炎或胆源性胰腺炎患者,如预计其可通过积极的内镜治疗获益,尽早行急诊ERCP是安全、有效的治疗手段。Objective To assess the proper timing, methods, safety and validity of emergency endoscopic retrograde cholangiopancre- atography（ERCP）. Methods A retrospective study was performed on 90 patients with acute obstructive cholangitis or biliary pancrea- titis who were admitted from September 2014 to December 2016. To observe abdominal pain, fever, the symptom such as skin yellow dye preoperatively and 3 to 10 days after operation. The clinical index such as blood pressure, blood routine,liver meritorious service, blood amylase and lipase were compared to evaluate the infection control, obstructive jaundice, ease and curative effect. Results A- mong 90 patients ,78 cases（ 86.0% ）were diagnosed as choledoeholithiasis, 1 case（ 1.0% ）was Mirrizz syndrome ,5 cases（6. 0% ）were malignant stricture of bile duet or pancreas and 6 cases （7.0%） had no positive found in cholangiography. All the patients were treated by emergency ERCP. The success rate was 100% for biliary drainage, including 61 cases of endoscopic nose-biliary drainage （ EN- BD）, 12 cases of endoscopic retrograde biliary drainage （ERBD）, 1 case of endoscopic metal biliary eudoprosthesis （EMBE）and 16 ca- ses of endoscopic sphineterotomy with ENBD （EST）. The remission rate of abdominal pain, infection and jaundice case rate were 100% ,90.7% and 85.2% , respectively. After treatment ,76 cases （84.4%） were clinically cured, 9 cases （ 10. 0% ） were clinical re- mission,and 5 cases （5. 6% ）were dead. Conclusion For the patients with moderate and severe acute obstructive cholangitis or biliary pancreatitis, an emergency ERCP should be done as soon as possible if the evaluation of endoscopic intervention is valid, and a timely emergency ERCP is safe and effective.

关 键 词：急诊 内镜下逆行胰胆管造影术 胆管炎 胆源性胰腺炎 

分 类 号：R657.4[医药卫生—外科学]