66例胆胰疾病逆行胰胆管造影诊治分析

目的： 探讨逆行胰胆管造影（ERCP）和内镜下Oddi括约肌切开（EST）在胆胰疾病诊疗中的应用效果.方法： 66例胆胰疾病患者行ERCP 68例次,其中 2例行2例次. 44例胆道梗阻患者同时行磁共振胆道成像（MRCP）,分析ERCP的诊疗效果,并与MRCP诊断胆管结石符合率相比较.结果： 66例行ERCP诊断胆总管结石31例（41.7%）,胆管狭窄 18例（27.3%）,乳头炎性狭窄11例（16.7%）,壶腹癌2例（3.0%）,慢性胰腺炎2例（3.0%）,乳头旁憩室综合征1例（1.5%）,单纯胰管显影1例（1.5%）.ERCP与MRCP 诊断胆总管结石的符合率为81.8%.术后出现并发症4例（5.9%）,其中轻型胰腺炎1例,高淀粉酶血症1例, 2例 EST术后出血,均经临床治疗痊愈.结论： ERCP具有创伤小、安全有效等特点,在胆胰疾病治疗中具有重要地位.

Clinical analysis on the diagnostic and therapeutic effects of ERCP for 66 patients with cholecystopancreatic disease

Objective: To investigate the therapeutic effects of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) for cholangiopancreatic disease. Methods: Sixty-six patients with cholecystopancreatic disease underwent ERCP, 2 cases of them underwent ERCP twice, the subsequent EST to remove the stones and to amputate papilla of Vater. Meanwhile in order to analyse the diagnostic and therapeutic effects of ERCP, MRCP was performed in 44 patients with bile ducts obstruction. To reduce complications, provide managements of prevention and treatment associated with the ERCP-induced complications. Results: The most frequent cause was cholelithiasis (41.7%),of them stricture of bile duct (27.3%) was the second frequent cause, constrictive papillitis was 3.09%, cancer of ampullae was 3.0%, chronic pancreatitis was 3.0%, periampullary diverticular was 1.5%, endoscopic retrograde pancreatography was 1.5%. These cases underwent ERCP to make the diagnosis of cholecystopancreatic disease and the subsequent EST to remove the stones, to open papilla of Vater. Only 4 patients of them has got the complications including mild pancreatitis in 1 patient, hyperamylasemia in 1 patient, gastrointestinal bleeding in 2 patient .Patients with these complications were all cured. Conclusion: The advantage of ERCP is mini- invasive, safe and efficient. ERCP has significant value in diagnosing and treating cholecystopancreatic disease.