治疗性ERCP在急症胆胰疾病中的应用

目的探讨治疗性内镜下逆行胰胆管造影术（ERCP）在急症胆胰疾病中的疗效与安全性。方法对本院4年来的64例急症胆胰疾病的治疗性ERCP进行回顾性分析。结果64例治疗性ERCP中，成功59例，成功率92．2％，其中ERCP＋内镜下鼻胆管引流（ENBD）25例，ERCP＋内镜下乳头括约肌切开术（EST）＋取石＋ENBD12例，ERCP＋EST＋取石5例、取蛔虫4例，ERCP＋EST＋ENBD5例，ERCP＋EST＋内镜下胆管塑料支架术（ERBD）6例，ERCP＋EST＋内镜下鼻胰管引流（ENPD）2例。操作时间20～70min，平均42min。失败5例。并发轻症胰腺炎1例，大出血1例。结论治疗性ERCP可迅速缓解急症胆胰疾病的病情，明显缩短病程，对急症胆胰疾病的治疗安全、有效。

The Application of Therapeutic ERCP in Acute Biliary and Pancreatic Diseases

Objective To explore the effect and safety of therapeutic ERCP in acute biliary and pancreatic diseases. Methods Sixty -four patients,44 acute obstructive cholangitis eases and 16 acute biliary pancreatic cases and 4 biliary ascariasis cases,were hospitalized from September 2004 to November 2008. Besides conventional managements, emergency therapeutic ERCP was performed, including endoscopic naso - biliary drainage （ ENBD ） and endoscopic sphincterotomy （EST ） and endoscopic nasopancreatic drainage （ENPD） and endoscopic retrograde biliary drainage（ ERBD ） with stent. Results 59 of all patients safely went through therapeutic ERCP. The success rate was 92.2%. 25 eases underwent ENBD. 12 cases accepted EST and ENBD. The stones of 5 cases were removed successfully after EST. Biliary ascariase of 4 cases were removed. 5 cases, 6 cases and 2 cases were accepted ENBD and ERBD and ENPD respectively after EST. Operation time was 20 - 70min. The mean time was 42 min. 5 cases failed. 1 case was compliated with mild pancreatitis and 1 case was eompliated with severe bleeding. Conclusions Therapical ERCP is a safe and effective choice in treating acute biliary and pancreatic disease. It may alleviate severity rapidly and shorten recovery time significantly.