内镜逆行胰胆管造影诊断胆胰疾病的临床意义

目的：探讨内镜逆行胰胆管造影(ERCP)对胆胰疾病的临床诊断价值．方法：289例患行常规ERCP检查。结果：ERCP成功267例(92．39％)，确诊病例230例(86．14％)，16例术后并发急性胰腺炎，发生率为5．93％．结论：ERCP诊断胆胰疾病具有痛苦少、并发症低、适应症广等优点。是一项值得推广应用的新方法。     

逆行胰胆管造影病人的护理

逆行胰胆管造影(ERCP)是诊断胆胰疾病的重要手段之一，它与B超CT等联合应用，使临床对胆、胰系统疾病的诊断达到了系统性、完整性的新高度，实施这一技术的安全性及成功率与护士的术前准备、术中配合、术后护理、十二指肠镜保养与消毒等工作关系很大，现将ERCP病人的护理体会介绍如下。     

胆管内预留导丝法在治疗性内镜逆行胰胆管造影术中的应用

目的 探讨胆管内预留导丝法在有乳头、胆管解剖变异的治疗性ERCP中的应用.方法 对乳头位置较偏、憩室内或憩室旁乳头、胆管有严重弯曲等解剖异常的患者造影成功后将导丝预留在胆管内,然后再进行治疗性操作.结果 成功率明显提高(92.45% vs 82.26%)、操作时间缩短[(40±15)min vs (55±20)min]、并发症发生率明显减少(5.66% vs 19.35%),没有严重并发症发生.结论 对有乳头、胆管解剖变异的患者行治疗性ERCP中应用胆管内预留导丝法效果肯定,临床上可以推广.     

逆行胰胆管造影检查15例报告

胰胆疾病常用的影像学诊断方法有 :逆行胰胆管造影 (ERCP)、B超、CT等 ,但近年来以ERCP最为受到临床医师的重视。我科对我院疑诊为胆管病变者行ERCP检查 ,与B超检查进行对比、探讨ER CP的诊断价值。1　材料与方法1 .1　一般资料本组 1 5例 ,男性 1 1例 ,女性 4例 ,年龄最小 2 5岁 ,最大 66岁。平均年龄 49岁。1 .2　临床表现持续性右上腹部隐痛或阵发性绞痛 1 2例 ,黄疸1 0例 ,发热 7例 ,进行性消瘦 2例。1 .3　ERCP检查前诊断根据症状、体征、结合B超、CT检查 ,诊断为慢性胆囊炎、胆石症 7例 ,胰头癌 3例 ,总胆管扩张 2例 ,黄疸…     

诊断性逆行胰胆管造影的健康教育

随着消化内镜的不断发展，内镜下逆行胰胆管造影术(ERCP)不仅是目前国内胰胆疾病的可靠诊断手段，而且是胰胆疾病内镜治疗的重要途径^[1]。通过简单明了的健康教育，可使患者明确ERCP造影检查的目的，了解检查方法，主动按照检查要求配合检查，克服检查中的种种不适，提高ERCP检查的成功率。我院内镜室自2001年10月～2002年6月进行诊断性ERCP术60例，现报告如下：     

磁共振胰胆管成像与经内镜逆行胰胆管造影对胆道梗阻性疾病诊断价值的比较

目的 比较磁共振胰胆管成像(MRCP)和经内镜逆行胰胆管造影(ERCP)对胆胰疾病的诊断价值.方法 对47例胆胰疾病患者行MRCP和ERCP检查,并进行对照分析.结果 MRCP和ERCP总的诊断准确率分别为85.1%和93.6%,对胆胰恶性疾病的诊断准确率分别为82.1%和89.2%,对胆总管结石的诊断准确率分别为89...     

内镜逆行性胰胆管造影术在胆胰疾病中的应用

目的:探讨内镜逆行性胰胆管造影术(ERCP)在胆胰疾病中的临床应用价值.方法:自2007年3月至2010年12月应用十二指肠镜治疗胆胰疾病856例.根据造影结果,选择性内镜下网篮取石、ENBD或胆管塑料支架(ERBD)等.观察终点为成功率及临床治疗效果.结果:856例ERCP中.内镜治疗成功率为97.7%,其中治疗性ERCP 822例,占98.3%.ERCP+EST+取石+ENBD治疗胆总管结石447例,其中415例一次性取尽结石,占93%;胆总管末段或乳头良性狭窄152例,其中124例ERCP+EST+ENBD,ERBD 28例;207例恶性胆道梗阻中ERBD 195例,12例十二指肠乳头壶腹癌活检明确诊断后行胰十二指肠切除术或胆肠吻合术;慢性胰腺炎伴胰管狭窄放置胰管内支架引流(EPBD)12例;医源性胆道损伤造影明确诊断后行胆管空肠Roux-en-Y吻合术18例.ERCP并发症7.9%,无穿孔及死亡病例.结论:ERCP及相关技术治疗胆胰疾病是安全、疗效确切的诊治方法,是临床实践中值得推广的微创治疗手段.对于部分经过严格选择的病例,可作为首选治疗.     

导丝应用于逆行胰胆管造影术中的技巧与护理

目的:探讨导丝应用于逆行胰胆管造影(ERCP)术中的技巧与护理配合方法。方法:选择2009年4月～2012年7月我院收治ERCP患者166例,术中予精心细致的手术配合。结果:成功完成诊断治疗160例,其中发生出血7例,胰腺炎4例。结论:导丝应用于ERCP术中具有重要作用,特别是对插管困难ERCP患者更为适用。灵活地应用导丝操作能够确保ERCP术的成功率,值得临床推广应用。     

经内镜逆行胰胆管造影在儿童胆胰疾病诊治中的应用及护理

总结15例儿童胆胰疾病应用经内镜逆行胰胆管造影诊治的护理。护理重点为做好术前准备和心理护理,术后做好饮食护理,加强并发症的观察与护理,重视鼻肠管及鼻胆管的护理,同时加强疼痛评估和护理,出院前做好健康宣教,预防复发。15例手术顺利,住院5~12d,均治愈出院。     

经内镜逆行胰胆管造影治疗90岁以上胆胰疾病患者的护理

总结经内镜逆行胰胆管造影治疗11例90岁以上胆胰疾病患者的护理。认为护理重点是治疗前做好心理护理及体位训练;治疗后加强病情观察及一般护理,做好鼻胆引流管和内支架的护理,重视并发症的观察与护理,给予营养支持。11例经内镜逆行胰胆管造影均成功,住院6~71 d,平均26.5 d。     

Pancreatic endoscopic retrograde cholangiopancreatography (ERCP)

We review developments in five areas of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) and management of pancreatic tumors during the period September 2005-August 2006. First, in the management of painful chronic pancreatitis, the use of multiple plastic stents for aggressive dilation of strictures located in the head of the pancreas has been put forward to resolve two significant issues associated with current techniques, i. e., the requirement for numerous ERCPs for stent exchange and the high relapse rate after stent removal. We then discuss the identification of protective factors against post-ERCP pancreatitis following pancreatic sphincterotomy. Next, bearing in mind the prospect of increasing use of neoadjuvant chemotherapy for resectable pancreatic ductal adenocarcinoma, new evidence supporting the systematic use of self-expandable metal biliary stents before cancer staging is presented and critically considered. A French study on the natural history of intraductal papillary mucinous neoplasms, which reinforces the current recommendation not to operate on all of these patients, is also discussed. Finally two centers with a high volume of cases have reported their experience with the drainage of pancreatic fluid collections with or without endosonography (EUS) guidance. It appears that EUS has extended the applicability of endoscopic drainage but, for collections amenable to conventional endoscopic techniques, it remains uncertain whether safety and effectiveness are improved when EUS guidance is used. Technical requisites for long-term success of drainage have been confirmed: multiple, double-pigtail stents should be inserted for a minimum of 6 weeks. It has also become evident that training in this technique is insufficient at many centers.     

Meta-analysis of antibiotic prophylaxis in endoscopic retrograde cholangiopancreatography (ERCP)

BACKGROUND AND STUDY AIMS: Considerable controversy exists regarding the role of antibiotic prophylaxis prior to endoscopic retrograde cholangiopancreatography (ERCP), in that various studies of antibiotic prophylaxis have reached conflicting conclusions. The aim of this meta-analysis is to synthesize the data in order to determine whether antibiotic prophylaxis reduces the rate of occurrence of bacteremia and/or the rate of sepsis/cholangitis among patients undergoing ERCP. PATIENTS AND METHODS: Clinical trials were selected via Medline and Pubmed using subject words and textwords "ERCP", "antibiotic" and "antibiotic prophylaxis". Summary estimates of the risk ratios for the outcomes of bacteremia and sepsis/cholangitis were calculated. RESULTS: After 49 abstracts had been reviewed, seven randomized placebo-controlled trials of antibiotic prophylaxis prior to ERCP were identified. Upon further review, two studies were excluded because patients received antibiotics before and after the ERCP. Four studies reported on the clinical outcome of bacteremia. Five studies reported on the clinical outcome of sepsis/cholangitis. The summary relative risk of the association between antibiotic prophylaxis and bacteremia was 0.39 (95% CI, 0.12-1.29). For sepsis/cholangitis the summary relative risk was 0.91 (95 % CI, 0.39-2.15). CONCLUSIONS: Antibiotic prophylaxis prior to ERCP may reduce the incidence of bacteremia but this has little clinical relevance. Prophylaxis does not substantially reduce the incidence of sepsis/cholangitis and thus the routine use of antibiotic prophylaxis cannot be recommended.     

Accuracy of endoscopic retrograde cholangiopancreatography (ERCP) in differentiating benign and malignant pancreatic disease

Despite advent of CT and ultrasound, endoscopic retrograde cholangiopancreatography (ERCP) remains useful in the preoperative evaluation of the pancreas. Using radiographic criteria previously described, ERCP was accurate in 90% of 71 patients in differentiating benign from malignant disease. Diagnostic errors were caused by chronic pancreatitis mimicking carcinoma (N=4) and carcinoma developing in a gland with chronic pancreatitis (N=3) missed on ERCP. Chronic pancreatitis was associated with a normal ERCP in 10% (N=4) of patients.     

乳头括约肌预切开术在胆管插管困难经内镜逆行胰胆管造影术中的应用观察

目的 探讨针状刀及经胰管乳头括约肌预切开两种方式在胆管插管困难内镜逆行胰胆管造影术(ERCP)中的应用,观察其ERCP成功率及相关并发症情况.方法 对2005年6月～2010年7月行ERCP的2 012例患者进行回顾性分析,将选择性胆管插管困难而行乳头括约肌预切开术的145例患者分为经胰管乳头括约肌预切开法、针状刀乳头括约肌预切开法两组,比较两种预切开方法在胆管插管困难ERCP中插管成功率及并发症的发生情况.结果 行乳头括约肌预切开术者占7.2%(145/2012),预切开术病例ERCP总成功率为92.4%(134/145);其中经胰管预切开组成功率89.9%(80/89),针状刀预切开组96.4%(54/56),并发术后急性胰腺炎前者4.5%(4/89),后者1.8%(1/56),前者无穿孔发生,后者穿孔1例,占1.8%(1/56),均经治疗后康复,无术后出血及操作相关的死亡发生.两种预切开方法对胆管插管困难ERCP成功率的提高及并发症发生率差异无显著性(P＞0.05).结论 两种乳头括约肌预切开术在胆管插管困难ERCP的应用中安全、有效,可以提高成功率;虽然经胰管乳头括约肌预切开法术后胰腺炎发生较针刀法高,但不同预切开方式对提高插管成功率及相关并发症差异无显著性.     

How often does bacteraemia occur following endoscopic retrograde cholangiopancreatography (ERCP)?

In order to determine the risk of bacteraemia from ERCP, we cultured blood specimens from 83 patients before, during and 15 min, 1, 6, 12 and 24 hours after the examination as well as in the subsequent week whenever fever occurred. No bacteraemia was found in the 20 patients who had duodenoscopy only, i.e. in whom ERCP failed. Of the 20 patients with normal biliary and/or pancreatic ducts positive culture was obtained in one patient in whom inadvertent multiple injections of contrast material into the pancreatic duct had resulted in the occurrence of a pyelogram. Four positive cultures were found amongst the 43 patients in whom an obstructive pathology in the biliary or pancreatic system was present. These data support the need of on antibiotic prophylaxis for patients with valvular heart defects.     

内镜下逆行胰胆管造影术对医源性胆道损伤的诊断与治疗

目的探讨内镜下逆行胰胆管造影术（endoscopic retrograde cholangio-pancreatography,ERCP）对医源性胆道损伤的诊断与治疗价值。方法行常规胆管造影,透视下发现胆管梗阻时,如发现胆管完全梗阻或已中断,即停止操作;如发现胆管狭窄,采用扩张探条和柱状扩张气囊行狭窄段扩张,再放置塑料内置管。发现造影剂外溢时,如为肝外胆管漏,引流管置于肝内胆管,如为肝内胆管漏,则置于接近漏口的胆管中。发现胆管结石时,如条件许可则行括约肌切开取石。结果18例患者中13例成功接受内镜下治疗,其中9例患者疗效满意,避免了再次手术,疗效满意率69.2%,其余9例患者,除1例病情恶化外均接受手术治疗。该组未发生与内镜操作有关的并发症和死亡。结论对于手术造成的胆道损伤,ERCP不仅具有定性和定位的诊断意义,而且具有一定的治疗作用,多数的胆漏患者和部分胆管狭窄患者可通过内镜治疗痊愈,避免了再次手术的创伤。     

Small-bowel perforations related to endoscopic retrograde cholangiopancreatography (ERCP) in patients with Billroth II gastrectomy.

BACKGROUND AND STUDY AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) is one of the mainstays in the diagnosis and treatment of hepatobiliary and pancreatic diseases, and is also increasingly used for patients with previous Billroth II gastrectomy. The aim of this study was to review our experience of ERCP in patients with Billroth II gastrectomy, and the complications associated with this procedure. PATIENTS AND METHODS: The records of 110 patients with Billroth II gastrectomy, treated between January 1993 and December 1997, were received retrospectively. Details noted included indications for ERCP, therapeutic interventions, causes of failure, and complications. RESULTS: A total of 110 patients underwent ERCP; the total number of ERCP attempts was 185. The major indications for ERCP were cholangitis (31%), common bile duct stones (22%), and jaundice (15%). The endoscope was successfully passed up to the papilla in 134 examinations (71%), and selective cannulation was successful in 122 of these (66%). There were 63 (34%) failed ERCP attempts. Causes of failure were: difficulty in entering the afferent loop (n = 19, 10%), failure to enter the duodenum (n = 23, 12%), endoscope-related bowel perforation (n = 9, 5%), and failed cannulation (n = 10, 6%). The other two failures were caused by desaturation in the patient, and inability to distend the duodenum. The major complication of the procedure was perforation, which occurred in 11 examinations (6%). Of these perforations, nine occurred in the small bowel while the endoscope was being manipulated through the afferent loop; these patients required laparotomy. Two patients had retroduodenal perforations, one occurring after sphincterotomy and one after cannulation. Both patients were successfully managed conservatively. Three patients suffered bleeding after sphincterotomy (3/185 procedures, 1.6%), and one patient developed acute pancreatitis. These were managed conservatively. The overall complication rate was 8%. There were two deaths among the patients with small-bowel perforations, and consequently an overall mortality rate of 1% (2/185 procedures). CONCLUSIONS: Most complications of ERCP in patients with previous Billroth II gastrectomy were caused by bowel perforation while the endoscope was being manipulated through the afferent limb. Such perforations are intraperitoneal and require surgical intervention.     

右美托咪定在经内镜逆行胰胆管造影术的应用进展

经内镜逆行胰胆管造影术(ERCP)是一种微创手术,目前已广泛用于胰胆管疾病的诊断与治疗,但与普通内镜检查相比,治疗性ERCP具有其特殊性。右美托咪定(dexmedetomidine,Dex)是一种新型的、高选择性的α2肾上腺素能受体激动剂,具有镇静、镇痛和抗焦虑等作用,常用于ICU患者的镇静、多种侵入性操作的麻醉以及复合麻醉,近年也常将其用于ERCP的麻醉。