ERCP在诊治十二指肠壶腹周围疾病中的应用  

The Clinical Usage of ERCP in the Diagnosis and Therapy of Periampullary Diseases

作　　者：何国杰[1] 姚礼庆[1] 高卫东[1] 周平红[1] 徐美东[1] 钟芸诗[1] 

机构地区：[1]复旦大学附属中山医院内镜中心,上海200032

出　　处：《中国临床医学》2003年第4期503-505,共3页Chinese Journal of Clinical Medicine

摘　　要：目的 :探讨ERCP在诊断和治疗十二指肠壶腹周围良恶性疾病中的应用。方法 :自 1999年 1月～ 2 0 0 3年 4月 ,173例壶腹周围良恶性疾病患者经ERCP选用十二指肠乳头活检 ,常规乳头切开或针刀切开 ,乳头气囊扩张 ,胆道结石取石术 ,放置鼻胆管、塑料内支架或金属内支架等方法。结果 :173例壶腹周围疾病中 ,良性病变 99例 ,95例 (95 .9% )得到内镜诊断或治疗 ,其中壶腹周围炎性狭窄治疗成功率 95 .4 % (83/ 87) ,同时伴有结石 4 0例 ,结石取出率 92 .5 % (37/ 4 0 ) ,其中乳头结石嵌顿取石治疗成功率 10 0 % (12 / 12 )。壶腹周围恶性肿瘤 74例 ,内镜活检病理证实壶腹周围腺癌 4 8例 (6 4 .9% ) ,经内镜引流共 4 3例 (5 8.1% ) ,其中鼻胆管引流 2 0例、塑料内支架 13例、金属内支架 10例。结论 :在乳头结石嵌顿、壶腹周围炎性狭窄治疗中 ,内镜治疗效果显著 ,在壶腹周围恶性肿瘤术前病理诊断、胆道置管减黄 ,晚期患者姑息性胆道置管引流中 。Objective: To discuss the clinical usage of ERCP in the diagnosis and therapy of periampullary diseases. Methods: There are 173 cases of periampullary diseases dealed with endoscopic methods, including biopsy、endoscopic sphincterotomy、endoscopic papillary balloon dilatation、ENBD、ERBD or EBMSD. Results: In all the cases, there are 99 benign cases, and 95 of them (95.9%) were dealed with endoscopic methods: all the patients(12/12)of stone embed in the papilla were cured; 95.4% (83/87) patients of periampulla inflammatory stricture were cured; the successful rate of pulling out the stone is 92.5% (37/40). There are 74 malignant cases: 48 cases (64.9%) were approved as carcinoma of periampullae through biopsy; 43 cases (58.1%) were dealed with drainage through ERCP: 20 cases were dealed with ENBD、13 cases were dealed with ERBD、10 cases were dealed with EBMSD. Conclusions: ERCP can be used to cure stones embed in ampullae、periampulla inflammatory stricture. And ERCP can be used to biopsy or drainage in the malignant diseases of periampullae.

关 键 词：ERCP 十二指肠疾病 壶腹周围疾病 胆道置管引流 影像学诊断 

分 类 号：R656.6[医药卫生—外科学] R814.42[医药卫生—临床医学]