ERCP治疗医源性胆道损伤应用价值（附27例分析）

目的 探讨ERCP对医源性胆道损伤的诊断与治疗。方法 回顾2009年1月至2011年1月收治的医源性胆道损伤27例，先行ERCP检查，明确损伤的部位、性质及程度，继而行内镜下乳头括约肌切开（EST），胆道球囊扩张及鼻胆管引流（ENBD）或胆道内支架植入术（ERBD）。结果 27例胆道损伤病人，除1例恶性肿瘤病人死于肿瘤转移，其余26例病人临床症状完全缓解；10例胆瘘者内镜引流术，腹腔平均胆汁引流量由术前300mL/d减至50mL/d以下，两者比较有显著性减少（P<0.01），窦道多在1~2周内自行愈合。发生黄疸者19例，治疗后第1天平均总胆红素由术前（65.2±11.6）μmol/L下降到（31.6±9.1）μmol/L，治疗前后相比有显著性降低（P<0.01）。3例患者术后出现一过性血淀粉酶增高，4～6d后恢复正常，1例出现胆道感染，无出血、穿孔和急性胰腺炎发生。结论 ERCP可作为处理胆道手术并发症如大流量胆瘘和或胆道狭窄的首选治疗。内镜下乳头括约肌切开鼻胆管引流能降低胆道内的压力，减少瘘口流量，促进瘘口闭合；大口径内支架植入能有效扩张狭窄胆管，有利于胆汁排泄通畅。

Applied value of ERCP in the treatment of iatrogenic biliary injuries(A report of 27cases)

Objective To explore the value of ERCP in the treatment of iatrogenic biliary injuries. Methods From Jan 2009 to Jan 2011,27 Patients with iatrogenic biliary injuries treated with therapeutic endoscopic retrograde cholangio-pancreatography (ERCP)were retrospectively analyzed. Firstly, the patients received examination of ERCP in order to locate and estimate the site and degree of biliary injuries, and then followed by EST, ENBD or ERBN for treating biliary leakage or stricture. Results Of these 27 cases, 26 cases were complete remission, one case died of tumor metestasis. In the 10 cases with biliary leakage, 300ml/day of average peritoneal biliary drainage were decreased to below 50 mL/d after endoscopic drainage. The sinuses were healed in 2 weeks. In the 19 cases with jaundice,the serum total bilirubin from preoperative average 65.2±11.6 μmol/L was decreased to 31.6±9.1μmol/L first day after operation. Three cases had short-term increase of serum amylase and restored to normal in 4-6 days. One case complicated biliary infection. No bleeding, perforation of biliary tract and acute pancreatitis were found after operation. Conclusion For biliary surgery, such as big flow biliary leakage or biliary stricture ERCP may serve as the first choice of treatment. Use of endoscopic sphincterotomy and endoscopic naso-bile duct drainage could decrease biliary pressure, fistulous flow and promote fistulous healing.The big caliber stent placement may effectively dilate strictured biliary duct and maintain biliary fluency.