ERCP技术在胆管癌消化内镜诊治中的应用价值

目的探讨消化内镜下应用逆行胰胆管造影技术（Endoscopic Retrograde Choledochopancreatography,ERCP）技术对胆道恶性肿瘤的诊断及治疗的临床价值。方法分析38例胆管癌患者的ERCP下影像学诊断要点,并探讨十二指肠镜下胆管引流术对该病的治疗作用及术后并发症的发生情况。结果38例梗阻性黄疸患者经ERCP确诊为肝门部胆管癌5例、肝门以下33例;行胆管塑料支架内引流术（Endoscopic Retrograde Biliary Drainage,ERBD）者24例、金属支架内引流术（Endoscopic Metal Biliary Endoprothesis,EMBE）者9例,5例接受了内镜下鼻胆引流管置放术（Endoscopic Nasobiliary Drainage,ENBD）;除肝门部胆管癌患者外,其他胆管癌患者在治疗术后2周黄疸症状均得到了完全缓解[（91.5±22.6）umol/Lvs.（26.8±10.4）umol/L,P＆lt;0.01],所有患者2周后ALT较前明显下降（P＆lt;0.05）,且一般状况好转;追踪随访发现术后3个月内塑料支架堵塞率25.0%（6/24例...

The Application Value of ERCP in Diagnoses and Therapeutics for Cholangiocarcinoma by Endoscopy

Objective To study the clinical value of application of ERCP in diagnoses and therapeutics for cholangiocarcinoma by endoscopy. Methods To analyze the imaging diagnosis characteristics of ERCP in 38 cholangiocarcinoma cases, and to investigate the therapeutical effects and postoperative complication incidences of endoscopic retrograde biliary drainages by ERCP. Results Among the 38 obstructive jaundice cases 5 were given the definite diagnosis by ERCP as hilar cholangiocarcinoma, and the other 33 cases were cholangiocarcinomas below the hilar; Among the cases, there were 24 received ERBD, 9 received EMBE and 5 received ENBD; except hilar cholangiocarcinoma cases, the jaundice symptoms of the others had been complete remission [ （91.5 ± 22.6） umol/L vs. （ 26.8 ± 10.4） umol/L, P〈0.01） ]about 2 weeks after theraputic ERCP, on the other hand, in all the cases the ALT level decreased significantly （P〈0.05） after 2 weeks, and at the same time, the patients＇s general conditions improved as well; the follow-up studies found that in 3 months the blockage rate of plastic stent was 25.0% （6/24 cases）, and in 6 months the blockage rate of all of the stents was 51.5%（17/ 33 cases）; in the cases who received ERBD, the incidence complications of hyperamylasemia, acute pancreatitis and cholangeitis were 45. 5% （15 cases）, 6.1% （2 cases）, 24.3% （8 cases） respectively; The incidence of bile duct infection in hilar cholangiocarcinomas patients was significantly higher than that in the patients with the other parts of the tumor （80%, 4/5 cases）. Conclusion ERCP has high diagnosis rate for cholangiocarcinoma and exact therapeutics effect for reducing jaundice. The key to reducing post-operative complications was smooth drainage without stent obstruction