内镜逆行胰胆管造影术在肝棘球蚴病合并胆道病变患者中的应用  

Application of ERCP in patients with hepatic hydatid disease complicated with biliary tract disease in Lhasa

作　　者：黎燕 梁建 次旦央宗 益西旺扎 巴桑卓玛 伊比然恨 刘揆亮 LI Yan;LIANG Jian;Cidanyangzong;Yixiwangzha;Basangzhuoma;Yibiranhen;LIU Kuiliang(Department of Gastroenterology,Lhasa People's Hospital,Lhasa,Xizang 850000,China;Department of Gastroenterology,Beijing Friendship Hospital,Capital Medical University,Beijing 10000,China)

机构地区：[1]拉萨市人民医院消化内科,西藏拉萨850000 [2]首都医科大学附属北京友谊医院消化内科,北京100000

出　　处：《中国热带医学》2024年第9期1084-1088,1148,共6页China Tropical Medicine

基　　金：国家临床重点专科建设项目(拉萨市人民医院消化内科)。

摘　　要：目的报道西藏拉萨地区行内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)治疗的肝棘球蚴病患者,探讨ERCP在该地区肝棘球蚴病患者中的应用价值。方法通过回顾2019年6月—2023年8月在拉萨市人民医院收治的行ERCP操作的肝棘球蚴病患者,依据行肝棘球蚴手术与否及时间分为术前ERCP组(2例)、术后ERCP组(3例)和非手术组(11例,12次),评估ERCP在肝棘球蚴病患者中的应用价值。结果本研究共纳入行ERCP操作的肝棘球蚴病患者16例(17次),囊型∶泡型=12∶4,年龄(54.38±21.93)岁,男女比例为1∶1.67,合并胆总管结石9例(56.25%),合并胆管狭窄5例(31.25%)。术前ERCP组均因急性胆管炎行经内镜鼻胆管引流术(endoscopic na‑sobiliary drainage,ENBD)。术后ERCP组1例因肝棘球蚴术后胆漏行ENBD,2例因肝棘球蚴术后复发伴胆总管结石行ERCP取石。非手术组6例(7次)因胆总管结石行ERCP取石,3例因胆管狭窄行胆管引流,1例因肝棘球蚴囊腔破入胆道伴胆总管结石行ERCP清理胆道,1例因急性胆管炎行ERCP于胆道内取出乳白色扁平膜样物。ERCP相关并发症1例(5.88%),为胆道出血,保守治疗缓解。经手术及ERCP治疗,治愈8例(50.00%),显效5例(31.25%),有效3例(18.75%)。随访(28.56±17.11)个月,13例转归良好,3例分别于术后29、31及44个月死亡。囊型棘球蚴病患者疗效优于泡型棘球蚴病患者(P<0.05)。结论ERCP可用于肝棘球蚴病患者合并急性胆管炎、胆漏、胆管狭窄、胆总管结石及肝棘球蚴囊腔破入胆道的处置,安全且有效。Objective This study aimed to report the application of endoscopic retrograde cholangiopancreatography(ERCP)in patients with hepatic hydatid disease(HHD)in Lhasa,Xizang,and to explore the application value of ERCP in these patients.Methods By reviewing cases of HHD treated with ERCP at Lhasa People's Hospital from June 2019,to August 2023,the patients were divided into three groups based on whether they underwent hepatic hydatid surgery operation and the timing of the surgery.The groups were the preoperative ERCP group(2 cases),postoperative ERCP group(3 cases),and nonoperation group(11 cases,12 times).The study evaluated the application value of ERCP in patients with hepatic echinococcosis.Results A total of 16 patients(17 times)with HHD who underwent ERCP were included in this study(cyst type∶alveolar type=12∶4),with an average age of(54.38±21.93)years and a male-to-female ratio of 1∶1.67.Nine cases(56.25%)had choledocholithiasis,and 5 cases(31.25%)had biliary strictures.In the preoperative ERCP group,all patients underwent endoscopic nasobiliary drainage(ENBD)for acute cholangitis.In the postoperative ERCP group,one case underwent ENBD for postoperative biliary leakage,and two cases underwent ERCP for stone removal due to recurrence of choledocholithiasis after hepatic echinococcosis surgery.In the non-operation group,6 cases(7 times)underwent ERCP for choledocholithiasis,3 cases underwent endoscopic biliary drainage for biliary stricture,1 case underwent endoscopic biliary clearance for the intrabiliary rupture of hepatic hydatid cyst combined with choledocholithiasis,and 1 case underwent ERCP for acute cholangitis caused by a white flat membrane-like material in the biliary tract.ERCP-related complications occurred in one case(5.88%),namely,biliary hemorrhage,which was relieved by conservative therapy.After surgery and ERCP treatment,8 cases(50.00%)were cured,5 cases(31.25%)were obviously relieved,and 3 cases(18.75%)were slightly relieved.With a follow-up of(28.56±17.11)months,13 cases had a good out

关 键 词：肝棘球蚴病 内镜逆行胰胆管造影术 急性胆管炎 胆漏 胆管狭窄 

分 类 号：R532[医药卫生—内科学]