ERCP在胆道外科治疗中的应用

目的探讨ERCP在胆道外科治疗中的应用价值。方法回顾性分析近3年（2003年1月至2006年1月间）胆道术后残余结石及再生结石行乳头括约肌切开取石122例,腹腔镜胆囊切除术（LC）术后胆瘘行鼻胆管引流（ENBD）13例,原位肝移植术后胆管狭窄行胆管球囊扩张,放置胆管内支架或鼻胆管引流6例。结果122例胆道术后残余结石及再生结石患者经十二指肠镜胆道造影（ERC）成功率95.9%,取石成功率91.5%,其中有5例经2次操作取尽结石。13例胆瘘患者经鼻胆管引流2～3周后,胆瘘处均闭合,无严重并发症发生。6例胆管狭窄患者经ERC胆道介入（球囊扩张、ENBD或内支架）均治愈。结论ERCP在胆道外科治疗中具有重要应用价值,是术后残余结石或再生结石、术后胆瘘及术后胆管狭窄的有效介入方法。     

经内镜逆行胰胆管造影治疗十二指肠乳头憩室合并胆总管结石的临床价值

回顾性分析2014年1月至2017年12月在蚌埠市第三人民医院接受ERCP取石治疗的171例十二指肠乳头憩室合并胆总管结石的患者资料。患者均成功完成ERCP取石治疗,平均手术时间（35.6±7.9）min,平均插管时间（6.5±2.1）min,插管成功率100％。167例患者取净结石,一次取石成功率 97.7％（167／171）。7例（4.1％）患者术中出血,1例（0.6％）患者发生迟发性出血;术中及术后无一例患者发生穿孔;3例（1.8％）患者术后发生急性胰腺炎。术后随访时间12～24个月,随访期间,所有患者健康生存,无严重并发症发生。ERCP治疗十二指肠乳头憩室伴胆总管结石安全有效。     

儿童经内镜逆行胰胆管造影术后并发症分析

目的 研究经内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)在儿童胆胰疾病诊治中并发症的发生情况、影响因素及相应处理,以探讨其安全性、有效性。方法 回顾分析2008年1月至2017年12月期间于杭州市第一人民医院消化内科住院接受ERCP诊治的共172例16岁以下患儿的临床资料,对麻醉方式、疾病诊断、治疗方法、术后并发症情况进行研究分析。结果 172例患儿共接受375次ERCP操作,胆道疾病210例次（56.0%）,胰腺疾病245例次（65.3%）。分别完成胆、胰管开口切开,胆、胰管取石,胆、胰管内支架置入,鼻胆管、鼻胰管引流等相关操作。操作成功率为99.5%（373/375）,操作相关并发症的发生率为6.7%（25/375）,包括13例次（3.5%）术后胰腺炎,8例次（2.1%）术后出血,6例次（1.6%）术后胆管炎,并发症均于治疗后缓解。无重症胰腺炎、穿孔、ERCP相关死亡发生。首次ERCP操作及反复多次插管的术后胰腺炎风险更高（P<0.05）,十二指肠乳头切开患儿术后出血风险更高（P<0.05）。结论 儿童ERCP术后并发症发生率与成人相近,并且与治疗方法有关,内镜医师应高度重视并及时处理并发症。由经验丰富的内镜医师选择合适的方法操作时,儿童ERCP仍可被视为安全、有效的。     

毕Ⅱ式胃切除术后内镜下逆行胰胆管造影术的回顾分析

目的 评价毕Ⅱ式胃切除术后内镜下逆行胰胆管造影术（ERCP）治疗胆胰疾病的有效性和安全性,并初步总结经验。 方法 回顾性分析2011年1月至2016年12月长海医院消化内镜中心237次ERCP治疗的178例毕Ⅱ式胃切除术后胆胰疾病患者的临床资料,总结ERCP操作成功率及相关并发症发生情况。 结果 内镜到达十二指肠乳头的进镜成功率为83.5%（198/237）,选择性胆胰管插管成功率为91.4%（181/198）,完成预期操作的治疗成功率为98.9%（179/181）。毕Ⅱ式ERCP的总成功率为75.5%（179/237）,各年总成功率呈上升趋势。其中胆总管结石ERCP总成功率为85.2%（127/149）,结石一次取净率为56.7%（72/127）。毕Ⅱ式ERCP相关并发症发生率为14.3%（34/237）,其中穿孔1.7%（4/237）、出血1.3%（3/237）、胰腺炎3.4%（8/237）、无症状性高淀粉酶血症8.0%（19/237）。1例穿孔和2例重症胰腺炎患者,因继发感染性休克、多器官功能衰竭而死亡（1.3%,3/237）。大部分ERCP相关并发症经药物保守治疗或内镜再次干预得以好转（91.2%,31/34）。 结论 毕Ⅱ式胃切除术后ERCP总体上是有效和安全的,随着内镜技术的发展和术者经验的成熟,进镜、选择性胆胰管插管和治疗性干预的成功率均可接近正常解剖结构患者,相关并发症发生率较低。     

Billroth Ⅱ式胃切除术后患者ERCP诊治

目的 总结BillrothⅡ式胃切除术后患者进行ERCP诊治的经验,对其手术操作的成功率、安全性和有效性进行评估.方法 回顾性分析2007年1月至2009年11月间,75例BillrothⅡ式术后因胆道疾患接受ERCP诊治患者的临床资料.结果 75例患者中,顺利进入空肠输入襻69例（92%）,其中选择性胆道插管成功68例,3例行诊断性胆道造影检查,65例为治疗性操作.后者中16例行EST＋取石＋鼻胆管引流术,19例行塑料支架胆管引流术,18例金属支架胆管引流术,12例内镜下球囊扩张术＋取石＋鼻胆管引流术.1例患者因空肠输入襻穿孔（1.3%）急诊行手术治疗,2例（2.6%）并发术后急性胰腺炎,经保守治疗痊愈,无出血相关并发症.结论 对于BillrothⅡ式术后患有胆道疾病的患者,进行ERCP诊治是安全、可行的.     

数字胆道镜辅助无射线内镜逆行胰胆管造影术治疗胆管结石的有效性及安全性研究

目的　探讨数字胆道镜辅助无射线内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography, ERCP）治疗胆管结石的有效性和安全性。方法　回顾性收集2019年5月—2021年9月在东南大学附属中大医院采用数字胆道镜辅助无射线ERCP治疗胆管结石患者的临床资料,分析患者基线资料、插管成功率、一次取石成功率、操作时间、总住院时间和手术并发症,随访胆管结石复发情况。结果　共纳入170例患者,术前影像学检查中有156例（91.8%）患者检出胆管结石,结石长径为（7.7±4.1）mm。所有患者在胆道镜探查时发现胆管结石,并成功完成数字胆道镜辅助无射线ERCP取石治疗,插管成功率100.0%（170/170）。一次取石成功率为96.5%（164/170）,6例（3.5%）患者因巨大结石（长径>30 mm）行分次取石治疗。胆道镜探查时间（9.6±2.7）min（6~24 min）,手术时间（35.9±17.3）min（13~85min）,总住院时间（6.3±2.2）d（5~10 d）。术后3例（1.8%）患者出现术后胰腺炎,均为轻症,予对症治疗后缓解。患者术后1个月随访均未见胆管结石复发。结论　数字胆道镜辅助无射线ERCP治疗胆管结石安全有效,可避免辐射,值得进一步推广。     

LC联合术中ERCP一期治疗胆囊结石合并胆总管结石的临床分析

目的探讨腹腔镜胆囊切除术（LC）联合术中内镜下逆行胆胰管造影（ERCP）及乳头切开（EST）取石一期治疗胆囊结石合并肝外胆管结石的可行性和安全性。方法回顾分析应用LC联合术中ERCP一期治疗胆囊结石合并肝外胆管结石36例的临床资料,分析原发病、手术方式、术后康复、住院时间及并发症。结果术前明确胆总管结石31例中10例先行术中ERCP取石,取石成功后再行LC;余21例和5例术前怀疑胆总管结石、术中经胆囊管胆道造影（TCC）证实胆总管结石者先行LC,继而行ERCP取石。LC手术均获成功,ERCP取石成功率为97.22%。术后5例出现一过性血淀粉酶升高,无明显出血、胆漏等并发症,术后住院平均为4 d。结论 LC联合术中ERCP一期治疗胆囊结石合并肝外胆管结石安全、有效,可避免不必要的ERCP及因术后ERCP失败而致患者再次手术。     

90岁及以上高龄患者治疗性经内镜逆行胰胆管术的临床分析

目的探讨治疗性经内镜逆行胰胆管造影术（ERCP）在90岁及以上高龄患者中的应用指征、疗效及安全性。方法回顾性分析2001年1月1日至2014年3月31日、年龄大于或等于90岁行ERCP患者的病史资料,对其临床特征、ERCP操作情况及术后并发症进行分析。结果97例90岁及以上高龄患者共进行113次ERCP操作,包括肝外胆管结石和／或胆道感染74例、胆胰恶性疾病18例及其他胆胰良性疾病5例,插管成功率96．5％（109例次）,操作成功率92．0％（104例次）。ERCP术后并发症发生率11．5％（13例次）,病死率3．1％（3例）,其余并发症程度均较轻,能较快缓解。结论90岁及以上高龄患者行ERCP术有效而安全,但仍需更多研究支持。     

ERCP治疗肝移植术后胆道并发症的疗效评价

目的探讨ERCP在治疗肝移植术后胆道并发症方面的作用。方法回顾性分析2004年10月至2007年10月采用ERCP治疗39例肝移植术后胆道并发症患者的临床资料。对25例胆道狭窄患者（吻合口狭窄14例,非吻合口狭窄11例）行括约肌切开、胆管扩张、鼻胆管引流和塑料内支架置放术等治疗;对6例胆漏患者行鼻胆管引流及塑料内支架置放术等治疗;对16例胆道结石和胆泥形成患者（其中合并胆道狭窄8例）行括约肌切开、鼻胆管冲洗引流及取石网篮取石等治疗。结果ERCP手术成功率为95．9％（94／98）,未出现严重并发症。吻合口狭窄的ERCP治愈率为100％（14／14）,非吻合口狭窄的ERCP治愈率为27．3％（3／11）,胆漏的ERCP治愈率为83．3％（5／6）,结道结石和胆泥形成患者的ERCP治愈率为81．3％（13／16）。结论ERCP治疗肝移植术后胆道并发症安全性较高、疗效较好、严重并发症发生率较低。     

内镜下十二指肠乳头预切术在恶性胆道梗阻诊治中的应用

目的 探讨内镜下十二指肠乳头预切术在恶性胆道梗阻诊治中的应用价值.方法 对46例插管困难的恶性胆道梗阻患者,根据十二指肠乳头及其周围结构、插管情况等采用不同预切方法对乳头括约肌施行内镜下预切术,观察ERCP诊治的完成情况,以及并发症发生情况.结果 应用弓形刀切开法4例、针状刀切开法24例、经胰管胆管切开法12例、联合方法6例,其中35例预切术后胆管插管成功,成功率达76.1%（35/46）.发生术后黏膜渗血3例、胰腺炎1例、高淀粉酶血症2例、胆管炎1例,未见穿孔发生.结论 内镜下乳头预切术可提高恶性胆道梗阻患者ERCP诊治的成功率,且适时、正确地应用可以降低并发症的发生率.     

A Prospective study of septic complications of endoscopic retrograde cholangiopancreatography

Abstract Prophylactic antibiotics are used in an attempt to avoid the septic complications of endoscopic retrograde cholangiopancreatography (ERCP). We prospectively performed blood cultures and surveyed patients for complications. The aims were first, to determine the incidence of bacteraemia associated with ERCP, second, to assess the incidence of clinical sepsis following the procedure and third, to evaluate the effectiveness of our antibiotic prophylaxis.
One hundred and fifty successive patients underwent 179 ERCP. Bacteraemia related to the procedure or the underlying pathology was found in nine procedures (5.2%). Bacteraemias were more likely to complicate therapeutic procedures ( P = 0.015), biliary obstruction ( P = 0.045) or underlying pathology ( P = 0.022).
Although 61% of ERCP received antibiotics, 22 septic events occurred. Five bacteraemic patients were septic despite antibiotics. Septic complications were associated with the same factors as bacteraemia.
It was concluded that patients with biliary obstruction and undergoing therapeutic endoscopic procedures are at greatest risk of bacteraemia. Single dose prophylactic antibiotics may not prevent sepsis in these patients and longer-acting drugs or repeated dosing may be necessary.     

经内镜逆行胰胆管造影916例临床分析

目的探讨经内镜逆行胰胆管造影(ERCP)在诊断及治疗胰胆道疾病中的应用价值及安全性,寻找提高ERCP操作成功率以及防止或减少并发症发生率的有效措施。方法2003年1月~2005年7月,我院接受ERCP诊断及治疗的患者916例,记录并分析其操作过程及术后并发症的发生。结果在916例患者中,总操作成功率为94.7%,共有128例患者接受十二指肠乳头肌预切开术。术后严重并发症发生率为5.4%(50例),其中包括胰腺炎33例,胆管炎10例,消化道出血4例和消化道穿孔3例。另外,有297例患者出现术后高淀粉酶血症(占32.4%)。结论对于胰胆道疾病患者,诊断性和治疗性ERCP是安全有效的诊治措施,其术后并发症主要有胰腺炎、胆管炎、消化道出血、消化道穿孔和高淀粉酶血症。十二指肠乳头肌预切开术有助于提高ERCP选择性插管的成功率。     

Application of single balloon enteroscopy-assisted therapeutic endoscopic retrograde cholangiopancreatography in patients after bilioenteric Roux-en-Y anastomosis: Experience of multi-disciplinary collaboration

BACKGROUND Bilioenteric Roux-en-Y anastomosis is one of the most complicated approaches for reconstructing the gastrointestinal tract, and endoscopic retrograde cholangiopancreatography(ERCP) is technically challenging in patients after bilioenteric Roux-en-Y anastomosis. The optimal endoscopic strategies for such cases remain unknown.AIM To explore the feasibility and effectiveness of single balloon enteroscopy-assisted(SBE-assisted) therapeutic ERCP in patients after bilioenteric Roux-en-Y anastomosis based on multi-disciplinary collaboration between endoscopists and surgeons as well as report the experience from China.METHODS This is a single center retrospective study. All of the SBE-assisted therapeutic ERCP procedures were performed by the collaboration between endoscopists and surgeons. The operation time, success rate, and complication rate were calculated.RESULTS Forty-six patients received a total of 64 SBE-assisted therapeutic ERCP procedures, with successful scope intubation in 60(93.8%) cases and successful diagnosis in 59(92.2%). All successfully diagnosed cases received successful therapy. None of the cases had perforation or bleeding during or after operation,and no post-ERCP pancreatitis occurred.CONCLUSION Based on multi-disciplinary collaboration, SBE-assisted therapeutic ERCP in patients after bilioenteric Roux-en-Y anastomosis is relatively safe and effective and has a high success rate.     

The clinical impact and cost implication of endoscopic ultrasound on use of endoscopic retrograde cholangiopancreatography in a Canadian university hospital.

BACKGROUND: Endoscopic ultrasound (EUS) is a safe alternative to endoscopic retrograde cholangiopancreatography (ERCP) for diagnostic biliary imaging in choledocholithiasis. Evidence linking a decline in diagnostic ERCP with the introduction of EUS in clinical practice is limited. OBJECTIVE: To assess the clinical impact and cost implications of a new EUS program on diagnostic ERCP at a tertiary referral centre. PATIENTS AND METHODS: A retrospective review was performed of data collected during the first year of EUS at the University of Alberta Hospital (Edmonton, Alberta). Patients were referred for ERCP because of suspicion of choledocholithiasis based on clinical, biochemical and/or radiological parameters. If they were assessed to have an intermediate probability of choledocholithiasis, EUS was performed first. ERCP was performed if EUS suggested choledocholithiasis, whereas patients were clinically followed for six months if their EUS was normal. Cost data were assessed from a third-party payer perspective, and cost savings were expressed in terms of ERCP procedures avoided. RESULTS: Over 12 months, 90 patients (63 female, mean age 58 years) underwent EUS for suspected biliary tract abnormalities. EUS suggested choledocholithiasis in 20 patients (22%), and this was confirmed by ERCP in 17 of the 20 patients. EUS was normal in 69 patients, and none underwent a subsequent ERCP during a six-month follow-up period. One patient had pancreatic cancer and did not undergo ERCP. The sensitivity and specificity of EUS for choledocholithiasis were 100% and 96%, respectively. A total of 440 ERCP procedures were performed over the same 12-month period, suggesting that EUS resulted in a 14% reduction in ERCP procedures (70 of 510). There were no complications of EUS. The cost of 90 EUS procedures was $42,840, compared with $108,854 for 70 ERCP procedures. The cost savings for the first year were $66,014. CONCLUSION: EUS appears to be accurate, safe and cost effective in diagnostic biliary imaging for suspected choledocholithiasis. The impact of EUS is the avoidance of ERCP in selected cases, thereby preventing the risk of complications. Diagnostic ERCP should not be performed in centres and regions with physicians trained in EUS.     

逆行胰胆管造影、乳头括约肌切开配合腹腔镜胆囊切除术治疗胆石症

为治疗伴有或可疑伴有胆总管结石的胆囊结石病人，在对胆囊结石病人行腹腔镜胆囊切除术（ＬＣ）时，对ＬＣ术前可疑伴有胆总管继发性结石的１４２例病人（术前组）和ＬＣ术后可疑胆总管残留结石的３９例病人（术后组）选择性地行逆行性胰胆管造影（ＥＲＣＰ）检查和乳头括约肌切开术（ＥＳＴ）治疗。结果：术前组ＥＲＣＰ发现胆总管继发结石６５例，ＥＳＴ清除结石６０例，清除率９１．５％；术后组ＥＲＣＰ发现胆总管残留结石６例，ＥＳＴ清除结石５例。结果提示ＥＲＣＰ、ＥＳＴ配合ＬＣ治疗伴有胆总管结石的胆囊结石病人是一种安全有效的好方法，明显减少了ＬＣ的并发症和胆总管结石开腹手术的比例。     

ERCP在老年胆胰疾病治疗中的临床应用

目的探讨逆行胰胆管造影术(ERCP)在老年胆胰疾病患者治疗中的应用价值及安全性。方法对2000年1月～2006年10月在我院收治的32例70岁以上的胆胰管疾病患者进行回顾性分析。结果32例老年患者行ERCP治疗36例次,成功率100%。进行单纯EST2例,EST加ENBD2例,EST加取石术19例(23例次),EST加取石术及ENBD2例,ENBD5例,ERBD2例。本组发生内镜有关的并发症4例,无死亡病例。术后各项指标与术前相比有明显好转。结论对胆胰疾病的老年患者行ERCP治疗具有创伤小、安全性好、并发症少、疗效确切等优点,值得临床推广应用。     

ERCP in patients 90 years of age and older

BACKGROUND: Biliary diseases represent particular diagnostic and therapeutic problems in elderly patients. METHODS: Patients 90 years of age or older who underwent ERCP from January 1993 to September 2001 were studied retrospectively. RESULTS: A total of 126 patients underwent 147 ERCP procedures (range 1-5 per patient). Twelve additional ERCPs were performed in 9 of the patients during follow-up because of recurrent symptoms. A total of 159 procedures were, therefore, available for analysis. The most frequent indications were suspicion of bile duct stones (46.8%) and obstructive jaundice (35.7%). Midazolam (95.6%) was used for conscious sedation and hyoscine (74.8%) for duodenal ileus. Patient tolerance of the procedure was good in 92.4% of sessions. Diagnoses included bile duct stones (54%), bile duct dilatation without any apparent obstruction (11.9%), and malignant stenosis (9.5%). Therapeutic procedures were indicated in 95.6% of diagnosed patients and completed in 96.3% of cases. Complications occurred in association with 2.5% of the ERCP procedures; the procedure-related mortality rate was 0.7%. CONCLUSIONS: ERCP in elderly patients is practicable. The complication rate is low, and therapeutic efficacy is good.     

169例高龄患者行治疗性ERCP的安全性和有效性探讨

目的通过比较不同年龄段患者内镜逆行胰胆管造影（endoscopicretrogradecholangiopancre—atography,ERCP）的应用情况,分析和探讨ERCP在高龄患者中应用的有效性和安全性。方法2010年1月～2012年12月,本院进行ERCP操作的患者169例,按年龄分组,其中≥70岁的患者（高龄组）83例,〈70岁的患者（非高龄组）86例。记录患者ASA分级、基础疾病、ERCP操作以及并发症情况,对结果进行统计分析。结果169例患者进行了181次ERCP操作。例数、性别比例在两组间差异无统计学意义（P〉0．05）。ERCP操作成功率、并发症发生率两组比较差异无统计学意义（P〉0．05）。高龄组患者ASA分级比非高龄组高,差异有统计学意义（P〈0．05）。高龄组胆道系统结石及胰腺或胆道恶性肿瘤显著高于非高龄组（P〈0．05）。结论高龄组进行ERCP操作能够取得和非高龄组一样的疗效,ERCP在高龄患者中的应用是安全、有效的。     

预切开窗后插管失败再次胆管插管的体会

目的探讨对经内镜逆行胰胆管造影术（ERCP）预切开或开窗方法后胆管插管失败者,行第2次ERCP操作的价值。方法167例患者术前拟诊胆总管结石和／或良性乳头狭窄109例,胆胰占位性病变58例。第一次ERCP标准胆管插管均在20min以上,不能成功后作预切开或开窗术,再反复试插后仍未能成功;3～5d后,再次行ERCP;第2次ERCP大多数患者按胆胰管合流水平位、前位和后位顺序插管。结果133例（79．6％）经第2次ERCP获得成功,其中水平位插管成功85例,前位插管成功36例,后位插管成功12例。插管成功后顺利完成了内镜的相应治疗。1例发生乳头穿孔伴后腹膜感染,1例并发重症胰腺炎形成胰周脓肿,均经腹腔穿刺引流方法治愈。结论经过更缜密的准备,掌控好胆管插管技巧,再次ERCP仍有较高的成功率。     

高龄患者行治疗性内镜逆行胰胆管造影的安全性和有效性探讨

[目的]探讨治疗性内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)在高龄患者中应用的有效性和安全性。[方法]将行治疗性ERCP操作的患者169例,按年龄分组,其中≥70岁83例(高龄组),70岁86例(非高龄组);记录2组患者ASA分级、基础疾病、ERCP操作以及并发症情况,对结果进行统计分析、比较2组患者治疗性ERCP的应用情况,[结果]169例患者进行了181次治疗性ERCP操作。2组间例数、性别比例均差异无统计学意义(P0.05),高龄组患者ASA分级、胆道系统结石及胰腺或胆道恶性肿瘤发生率均显著高于非高龄组(P0.05);治疗性ERCP后2组操作成功率、并发症发生率均差异无统计学意义(P0.05)。[结论]高龄组进行治疗性ERCP操作的疗效与非高龄组一致,治疗性ERCP在高龄患者中的应用是安全、有效的。