急性胆胰疾病的急诊内镜治疗

目的 探讨急诊治疗内镜在急性胆胰疾病中的临床应用价值.方法 自2007年3月至2010年5月急诊应用十二指肠镜治疗急性胆胰疾病103例.根据病情完成ERCP检查和放置鼻胆引流管(ENBD)或内镜下乳头括约肌切开术(EST).对于乳头部结石嵌顿用针型刀剖开乳头,然后根据病情进行网篮取石、ENBD或胆管塑料支架(ERBD),观察终点为治疗成功率,同时结合既往非急诊ERCP病例资料,针对内镜下操作次数进行了对比分析.统计学处理采用SPSS 13.0统计分析,率的比较采用x2检验,P＜0.05为差异有统计学意义.结果 103例急诊ERCP中,内镜治疗成功率为97.1%(100/103),其中ERCP+ENBD/ERBD、ERCP+针刀开窗术+取石/ENBD/ERBD、ERCP+EST+取石+ENBD以及ERCP+EST+ERBD分别为25例(24.3%),12例(11.7%),67例(65.1%)和8例(7.8%).ERCP治疗成功病例中,仅1例(1.0%)出现乳头出血,经内镜下止血后痊愈.与择期手术相比,急诊ERCP多需要二次操作完成治疗(P=0.010),治疗成功率两组差异无统计学意义(P=0.122).结论 急诊ERCP治疗急性胆胰疾病操作安全、疗效确切,是值得推广的微创治疗手段.

Clinical analysis of emergency ERCP for acute biliary-pancreatic diseases

Objectiye To investigate the clinical application value of emergency therapeutic encoscopic retrograde cholangio-pancreatography (ERCP) on acute biliary-pancreatic diseases.Methods Duodenoscope was applied on the emergency treatment for 103 patients of acute biliary-pancreatic diseases from March 2007 to May 2010. According to patients' conditions, the examination of ERCP,endoscopic nasobiliary drainage (ENBD) and endoscopic sphincterotomy (EST) were carried out. The papilla sphincter was slivered by needle knife under the circumstances of the stone incarceration in the papilla,then calculus was removed by net basket. ENBD or endoscopic retrograde biliary drainage (ERBD)was placed according to the state of an illness. Statistical analysis was made by SPSS 13.0 software with a 2 × 2 table analysis, Comparison of ratio were determined with x2 test, a value less than 0. 05 was considered as significant. Results Of 103 cases, the success rate of endoscopic treatment was 97. 1% ( 100/103 ).Among 100 cases, 25cases (24. 3% ) were treated with ERCP and ENBD/ERBD; 12 cases (11.7%) were treated with ERCP, needle knife fenestration and ENBD; 67 cases (65. 1% ) were treated with ERCP,EST, calculus removal and ENBD; 8 cases (7. 8% ) were treated with ERCP, EST and ERBD. Of 100 cases one (1.0%) suffered from postoperative hemorrhage of duodenal papilla, which was cured by endoscopic hemostasis. Compared with selective cases those undergoing emergency ERCP often needed two stage procedures (P = 0. 010), but there are no statistical differences between two groups in success rate (P = 0. 122). Conclusions Emergency ERCP are safe and effective in acute biliary-pancreatic diseases.