ERCP对成人先天性胆管囊肿的诊断及治疗价值

目的:评价经内镜逆行胰胆管造影(ERCP)对成人先天性胆管囊肿诊断和治疗的价值。方法:ERCP检查24例成人先天性胆管囊肿,并对其中11例合并梗阻性黄疸和化脓性胆管炎的病人及时行内镜下鼻胆引流术(ENBD)治疗。结果:按Todani的分类标准,ERCP检查发现Ⅰ型胆管囊肿14例(58.3%)、Ⅳa型8例(33.3%)、Ⅴ型即Caroli’s病2例(8.3%),其中包括囊肿癌变3例,胰胆管合流异常(APBDJ)4例。ERCP对胆管狭窄范围的判断及APBDJ的诊断优于CT及B超。ERCP治疗10例,包括胆管结石4例,胆管狭窄2例,胆管炎2例,囊肿癌变2例。ERCP治疗后1周内病人血白细胞计数、总胆红素、丙氨酸氨基转移酶、碱性磷酸酶明显下降。结论:成人先天性胆管囊肿Ⅰ型最为常见,胆管囊肿癌变率高、易合并相关的肝胆系统疾病。ERCP对胆管囊肿及APBDJ的诊断和分类较B超和常规CT检查更为直观、准确。ENBD治疗可迅速缓解梗阻性黄疸和化脓性胆管炎病人的症状,为进一步手术治疗创造良好的条件。

Diagnostic and Therapeutic Value of Endoscopic Retrograde Cholangiopancreatography in Adult Choledochal Cysts

Objective: To evaluate the value of diagnosis and treatment by endoscopic retrograde cholangiopancreatography(ERCP) in the adult choledochal cysts.Methods: Twenty-four cases of adult choledochal cysts were detected by ERCP.Eleven cases of them with obstructive jaundice and cholangitis were treated by endoscopic naso-biliary drainage(ENBD).Results: Fourteen type Ⅰ(58.3%),eight type Ⅳa((33.3%)) and two type Ⅴ(Caroli's disease)(8.3%) cases were diagnosed by ERCP according to Todani's classification.Among them,there were three malignancies and four abnormal pancreatobiliary duct junction(APBDJ).The diagnostic accuracy on the extent of biliary stenosis and APBDJ by ERCP was better than that of CT and ultrasonography.Among 10 cases treated by ERCP,there were 4 choledocholithiasis,2 biliary tract stricture,2 cholangitis and 2 malignancies.ERCP treatment led to significant decrease in WBC,STB,ALT and ALP in one week.Conclusion: Type Ⅰ cyst is the most common type of adult choledochal cysts which often presents high malignanacy and is more offen associated hepatobiliary disorders.ERCP offers more direct and accurate diagnosis on adult choledochal cyst than routine CT and ultrasonography.The symptoms caused by biliary obstruction and cholangitis can be relieved by ENBD,and better condition is created for further operative treatment.