PTCS诊断和治疗胆道疾病现状

随着CT、MRCP以及EUS等影像学检查飞速发展和普及，胆道疾病的病因诊断率显著提高，但仍有良恶性狭窄鉴别困难的病例。目前诊断性ERCP明显减少，主要是在治疗ERCP同时进行诊断，然而ERCP胆管细胞刷检或活检对恶性病变的阳性率仅约50％^[1]。经口胆道镜直视下在病变处活检，     

直接胆道内镜对胆管良、恶性狭窄诊断的临床评价

目的探讨经口直接胆道内镜对胆管良、恶性狭窄诊断的有效性和安全性.方法17例CT、MRCP证实胆管狭窄者在预先行EST或EPBD后用经鼻内镜经乳头插入胆管直至病变处,直视下观察病变处,结合活检,统计诊断准确性及活检阳性率、并发症发生率.结果17例内镜均成功插入胆管并得到明确的内镜诊断(100%).其中恶性狭窄15例、良性狭窄2例,诊断准确性100%.14例(82.4%)活检标本能满足组织细胞学检查,其中恶性狭窄12例,结果为腺癌9例(高分化腺癌5、中分化腺癌1、低分化腺癌2,不能分型1)、重度不典型增生1例、中度不典型增生1例、慢性炎症伴轻度不典型增生1例.活检敏感性75%,特异性100%.另2例良性狭窄者均为慢性炎症.无严重并发症发生.结论经口直接胆道内镜直视下观察并活检对胆管良、恶性狭窄的诊断有效而安全.     

影像学检查对肝门胆管狭窄的临床诊断价值

目的探讨分析肝门胆管狭窄常见病因并评价影像学检查对肝门胆管狭窄的诊断价值。方法回顾性分析1998—2007年北京军区总医院143例资料完整的肝门胆管狭窄患者病因及超声(US)、逆行胰胆管造影(ERCP)、经皮肝穿胆道造影(PTC)、磁共振胰胆管造影(MRCP)诊断结果,评价各影像检查对肝门胆管狭窄适应证及诊断价值。结果肝门胆管狭窄中恶性肿瘤占84.62%,良性病占15.38%。肝门胆管癌占72.73%,胆囊癌占6.98%,肝细胞癌并发门静脉癌栓2.80%,大肠癌肝门转移2.10%。良性狭窄以损伤性胆管、胆管囊肿、硬化性胆管炎、胆管结石及Mirizzi综合征多见。US、ERCP、PTC及MRI+MRCP诊断肝门胆管狭窄的准确率分别为84.62%、92.71%、100.00%、100.00%。结论现代影像学检查在鉴别肝门胆管狭窄良恶性病变方面具有重要的诊断价值,对其良恶性病灶可切除性进行准确的术前判断。     

PTCS诊断和治疗胆道疾病现状

随着CT、MRCP以及EUS等影像学检查飞速发展和普及,胆道疾病的病因诊断率显著提高,但仍有良恶性狭窄鉴别困难的病例。目前诊断性ERCP明显减少,主要是在治疗ERCP同时进行     

胆管腔内超声对良恶性胆道狭窄的鉴别诊断价值

目的评价胆管内超声对良恶性胆道狭窄的鉴别诊断价值。方法回顾分析2003年1月至2006年6月57例患者胆管狭窄行ERCP,所有患者均在行ERCP时用经导丝的UMG20-29R腔内超声探头扫查狭窄部位。结果手术病理或者细胞学刷检证实为恶性胆管狭窄者共31例,病理阴性且长期随访证实良性胆管狭窄者共26例,所有良性胆管狭窄的患者随访12～36个月。单纯细胞学诊断胆道狭窄的敏感性、特异性、阳性预测值、阴性预测值、准确性分别为39.1%、100%、100%、48.1%和61%。IDUS对胆管恶性狭窄判断的敏感性为80.6%,特异性为80.8%,阳性预测值为83.3%,阴性预测值为77.8%,准确性为80.7%。结论IDUS是一项安全可靠的技术,对胆管良恶性狭窄性质的鉴别有较高的价值。     

纤维内镜在胆管结石中的应用

经纤维十二指肠镜插管作肝、胆、胰管造影,对多种疾病具有较好的诊断和治疗价值,而临床上用于胆道疾病又最为广泛。本文就十二指肠镜在胆管结石中的应用作一扼要介绍。(一)内镜下逆行胰胆管造影(ERCP)一般认为,经临床和实验室检查诊断为阻塞性黄疸的病例,作ERCP 所得的胆管图象较口服胆囊造影或静脉胆道造影更为清晰,并能显示肝内胆管及胆管末端,有助于明确这些部位的病变性质,及结石的数目、大小、分布和胆管狭窄情况。ERCP 虽然是一种非创伤性检查,但由于设备要求较高和操     

内镜治疗恶性胆管狭窄的研究进展

胆管狭窄是指肝外或肝内胆管系统的区域狭窄,它可能是良性或恶性病变的结果,但76％～85％的胆管狭窄为恶性狭窄[1].因此临床上需要应用多种诊断技术来区分狭窄的良恶性.一旦被诊断为恶性狭窄,应立即实施手术和/或内镜下治疗以行根治性切除或姑息治疗.     

行ERCP＋ENBD＋EST术并发重症胰腺炎1例护理体会

ERCP是指经十二指肠镜逆行胰胆管造影术。适用于梗阻性黄疸、胰胆道结石症、肝胆管狭窄、壶腹部肿瘤、胆管肿瘤、胆道或胆囊术后综合征等检查。ENBD是指在十二指肠镜直视下实施的胆管置管引流减压技术又称鼻胆管引流术,是预防ERCP术后并发症的治疗方法。EST是指经内镜在十二指肠内镜逆行胰胆管造影ERCP和高频电息肉切除基础上发展而来的新技术,具有创伤小、恢复快、费用少、疗效确切等优点。     

胆囊切除术后综合征ERCP临床分析

目的:探究内镜逆行性胆胰管造影(ERCP)在胆囊切除术后综合征患者诊断及治疗中的临床应用价值。方法:选取接受ERCP检查的57例胆囊切除术后综合征患者的临床资料,并对该资料进行回顾性分析。结果:57例患者中53例插管成功,其中胆道结石30例,胆管扩张现象17例,胆管狭窄11例。3例胆囊管残留过长。1例胆道十二指肠瘘,1例胆管癌。结论:ERCP在胆囊切除术后综合征病因的明确方面具有较好的诊断价值,是一种较为可靠的方法。     

内镜逆行胰胆管造影下鼻胆管引流术前后的护理

内镜逆行胰胆管造影（ERCP）下鼻胆管引流术临床主要用于治疗各种良恶性胆道疾病引起的胆道梗阻,是一种有效的“减黄”和预防ERCP术后并发症的治疗方法,其操作简便、痛苦小、并发症少、成功率高。我科自2005年开始此项工作,至今共应用18例,同时实施针对性护理,获得良好效果,现将护理工作报告如下。     

经内镜逆行胆胰管造影术在胆总管壶腹区病变中的诊疗价值

目的：探讨经内镜逆行胆胰管造影（ERCP）术在胆总管壶腹区病变中的诊疗价值。方法：回顾性分析23例胆总管病变的影像学资料。全部病例行超声波检查、ERCP检查；其中9例行多层螺旋CT检查，5例行MRCP检查。结果：ERCP术能较好的显示胆总管及其病变，且能对胆总管结石、慢性炎症狭窄进行微创治疗。结论：ERCP对胆总管病变的检查优于CT、MRCP，特别对十二指肠壁壶腹区的占位病变较CT、MRCP检查有不可替代的优越性和诊断价值。     

诊断性ERCP在胆胰疾病中应用价值

目的 探讨ERCP对各种胆胰疾病的诊断及治疗价值.方法 回顾性分析该院肝胆胰外科2007年3月～2010年12月完成的ERCP 1 003例,对其中175例(17.45％)常规影像学检查未能确定诊断而经ERCP进行诊断和治疗的病例进行总结分析.镜下可疑乳头或壶腹肿瘤局部活检,确诊后部分病人根治性手术.选择性胆胰管造影,动态观察胆胰管扩张情况并注意结石及占位特征及胆胰管造影剂排空情况,根据ERCP诊断结果采取相应内镜下治疗措施.结果 175例ERCP检查中,成功率98.29％(172/175).均经ERCP检查确定病因和/或定位诊断.61例胆总管结石行EST切开取石或碎石,其中60例胆总管结石及2例胆道蛔虫症一次取出成功;49例十二指肠乳头、胆管下段炎性狭窄行EST; 33例ERCP诊断十二指肠乳头壶腹癌中15例行外科手术治疗;10例十二指肠乳头壶腹癌、6例胆管癌及胰腺癌、2例胆管良性狭窄及2例硬化性胆管炎行经内镜胆管内引流术(ERBD);15例医源性胆管损伤中5例胆瘘病人经ENBD后痊愈,10例经胆肠吻合术后痊愈.无严重并发症.结论 ERCP对部分胆胰疾病的诊断仍然有不可替代的作用,诊断的同时加做内镜下治疗是ERCP的突出优势,但要严格掌握适应证.     

The Endoscopic Retrograde Cholangiopancreatographic Manifestations of Histopathologically Diagnosed Hepatocellular Carcinoma with Obstructive Jaundice

To study the manifestation of endoscopic retrograde cholangiopancreatography(ERCP) in patients of obstructive jaundice associated with HCC ,32 cases of histopathologically diagnosed HCC with obstructive jaundice were successfully examined with routine ERCP.31 patients were demonstrated by ERCP as having malignant obstructive jaundice.Among them,19 were hepatic perihilar bile duct stricture,7 bile ductile tumorous thrombus,3 perihilar bile duct stricture complicated with thrombus,2 metastasis to hilar lymph node,and 1 common bile duct stone as proven by sphincterotomy.The maliganant perihilar stricture was all of type Ⅲ and IV by Bismuth standard of Klastin tumor.In patients identified as having bile duct tumor thrombus,by the Ueda classification,none was of type I and Ⅱ;1 type Ⅲa;4Ⅲa;2 type Ⅳ.HCC with obstructive jaundice was mainly caused by the malignant infiltration of tumor,and most stricture was of serious nature.When major extra-hepatic bile duct was involved by tumor thrombus,obstructive jaundice might develop.Malignant perihilar stricture and tumor thrombus might coexist in some patients.Jaundice was rarely caused by hepatic hilar lymph node metastasis.Jandice was not necessarily caused by tumors and sometimes,it might be caused by common bile stones.Care should be exercised in differentiation diagnosis in such patients.     

经内镜逆行胆管支架置入在恶性胆管狭窄姑息性减黄 治疗中的有效性和安全性分析

目的探讨经内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography,ERCP）置入胆管支架治疗恶性胆管狭窄所致梗阻性黄疸的有效性及安全性,筛选胆管支架引流效果预测指标。方法采用ERCP技术对106例不能手术切除的恶性胆管狭窄病人行胆管支架置入治疗。根据分析目的不同分为:恶性胆管狭窄肝门部与远端组;恶性肝门部胆管狭窄BismuthⅠ型与Ⅱ~Ⅳ型组;恶性肝门部胆管狭窄BismuthⅡ~Ⅳ型中单侧支架与双侧支架组;恶性远端胆管狭窄中塑料支架与金属支架组;支架引流有效与无效组。记录术前、术中及术后相关指标,比较术前术后及各组引流效果、术后并发症发生情况,分析筛选可能影响支架引流效果的相关指标。结果106例病人术后1周内血清总胆红素水平较术前明显下降（P < 0.05）,引流有效率70.8%。Bismuth Ⅰ型组、金属支架组引流有效率分别明显高于BismuthⅡ~Ⅳ型组、塑料支架组（P < 0.05）。恶性肝门部胆管狭窄较远端胆管狭窄的术后急性胰腺炎及急性胆管炎的发生率明显升高（P < 0.05）。术前血清白蛋白水平及术中回抽淤积胆汁量与引流效果呈明显正相关（P < 0.05）。结论经ERCP置入胆管支架的姑息性减黄治疗安全有效,但对于引流效果及术后并发症相对风险较高之BismuthⅡ~Ⅳ型组应谨慎对待。术前血清白蛋白水平及术中回抽胆汁量可预测支架引流效果。     

Clinical significance of magnetic resonance cholangiopancreatography utilizing half-Fourier acquisition single-shot fast spin-echo in diagnosing bile duct diseases

Objective: To investigate the clinical significance of magnetic resonance cholangiopancreatography(MRCP) utilizing half-Fourier acquisition single-shot fast spin-echo (HASTE) in the diagnosis of bile duct diseases.Methods: Forty-three patients with obstructive jaundice and 4 without were enrolled in this study. The underlying dis-eases included bile duct calculi(13 cases), chronic cholangitis (14 cases) malignant tumors (18 cases) and congeni-tal biliary cysts (2 cases). All patients underwent examinations with magnetic resonance imaging (MRI) and MRCP,and 39 were also examined with B-type ultrasonography, 33 with CT and 25 with ERCP and PTC. Three-dimensionalimage reconstruction was performed using volume-rendered technique (VRE) on the basis of the data obtained byMRCP. Results: The biliary calculi were displayed as circular filling defects in MRCP images, with the proximal endof dilated bile duct taking the form of the mouth of a cup. The bile duct of patients with chronic cholangitis showed dis-tal     

逆行胰胆管造影术在胆道良性疾病治疗中的应用

目的:探讨内镜下逆行胰胆管造影术(ERCP)在胆道良性疾病治疗中的临床特点。方法:选择胆道良性疾病患者22例,其中胆道结石15例,胆道狭窄1例,胆道蛔虫6例。对患者采用ERCP进行治疗。结果:本组患者22例,手术成功20例,成功率90.91%,失败2例,失败率9.09%。3例(13.64%)出现并发症,其中胆道感染1例,乳头切开口出血1例,急性胰腺炎1例,无死亡。结论:ERCP能够有效治疗胆总管结石、胆道狭窄及胆道蛔虫等胆道良性疾病,具有创伤小、治愈率高、并发症少、无相关死亡率的优点。     

ERCP对胆总管疾病的诊疗价值

目的：探讨经内镜逆行胆胰管造影（ERCP）对胆总管疾病的诊疗价值。方法：回顾性分析108例胆总管疾病行胆胰管造影的影像学资料。全部病例行超声波、MRCP检查,52例行多层螺旋CT检查。结果：ERCP术能较好的显示胆总管及其病变,且能对胆总管结石、慢性炎症狭窄等疾病进行微创治疗。结论：ERCP对胆总管病变的检查优于CT、MRCP,特别对十二指肠壁壶腹区的占位病变具有明显的优越性和诊疗价值。     

Application of endoscopic retrograde cholangiopancreatography in biliary-pancreatic diseases

Background Endoscopic retrograde cholangiopancreatography （ERCP） has been used increasingly for the treatment of choledocholithiasis, gallstone pancreatitis, and benign or malignant bile duct or pancreatic duct stenosis. The purpose of this study was to evaluate ERCP for the diagnosis and therapy of biliary-pancreatic diseases. Methods A total of 2075 patients who underwent diagnostic and therapeutic ERCP from June 2001 to March 2009 were analyzed retrospectively. Achievement and complication rates were calculated, and the therapeutic effect was observed. Results In all the 64 cases who underwent diagnostic ERCP, the procedure was successful, in 2011 cases therapeutic ERCP was performed, and the success rate was 94.6%. In the therapeutic ERCP cases, 1434 （93.0%） were successful among the 1542 cases of choledocholithiasis, and 422 （90.0%） of the 469 cases with benign or malignant bile duct or pancreatic duct stenosis, or acute obstructive suppurative cholangitis with stent placement or endoscopic nasobiliary drainage were successful. Fifty-nine （90.8%） cases of the 65 who underwent a pre-cut for pancreatic sphincterotomy were successful. Complication rate was 5.1% and the most frequent complication was acute pancreatitis （4.4%）. Conclusions ERCP is one of the major diagnostic and therapeutic methods for biliary-pancreatic disease. Therapeutic ERCP is a minimally invasive, safe and effective treatment method for various biliary-pancreatic diseases.     

磁共振胰胆管成像在胆道梗阻性疾病诊断中的应用

目的:探讨磁共振胰胆管成像(magnetic resonance cholangiopancreatography,MRCP)诊断胆道梗阻性疾病的价值及良、恶性梗阻性疾病的影像表现。方法:对45例胆道梗阻性疾病患者的MRCP和临床诊治资料进行回顾分析。结果:MRCP定位诊断准确率100.0%,定性准确率88.9%;胆道结石表现为胆管内充盈缺损、周围有胆汁包绕或为"杯口状"阻塞,胆管炎表现为胆管节段性扩张和狭窄,恶性病变表现为胆管突然截断或偏心性狭窄。结论:MRCP对胆道梗阻性疾病的诊断具有重要价值,应作为常规检查方法。