诊断及治疗性ERCP在肝胆管疾病中的应用

目的 评估经内镜括约肌切开取石（EST）治疗胆管结石的临床疗效,总结经验教训,同时进行生长抑素预防术后高淀粉酶血症的研究.方法 42例胆胰疾病患者同时进行了ERCP、B超和CT检查;ERCP和EST诊治肝胆管结石64例75例次;62例次患者分别于ERCP和EST术前和/或术后应用奥曲肽或施他宁后检测血尿淀粉酶.结果 B超诊断率为26.20﹪;CT诊断率为66.70﹪;ERCP诊断率为97.60﹪.75例次行ERCP或EST,成功70例次,失败5例次,成功率93.33﹪.36例EST中,胆总管单发结石14例;多发结石19例;33例取石成功.胰管显影30例,占40.00﹪.8例术后放入鼻胆管引流（ENBD）.并发症为ERCP和EST后胃肠道出血2例（2.67﹪）,急性胆管炎1例（1.33﹪）,急性胰腺炎2例（2.67﹪）.用奥曲肽后血、尿淀粉酶升高发生率为17.24﹪和34.48﹪;用施他宁者血、尿淀粉酶升高发生率为18.75﹪和25.00﹪;对照组血、尿淀粉酶升高发生率为64.71﹪和70.58﹪.奥曲肽组和施他宁组与对照组相比血、尿淀粉酶升高发生率显著减低（P＜0.01和P＜0.05）;施他宁组与奥曲肽组相比血、尿淀粉酶升高发生率差异无显著性（P＞0.05）;高淀粉酶血症主要发生在术后6 h内.结论 ERCP诊断胆胰疾病准确率高,EST更是一种相对安全有效的治疗胆管结石的方法.奥曲肽和施他宁可以减少术后患者血、尿淀粉酶的升高.

Diagnostic and therapeutic ERCP in patients with hepatobiliary diseases

Objective] To compare the diagnostic value of ERCP with abdominal B -ultrasound and CT in patients with hepatobilary diseases,to evaluate curative effect of EST, and to study the effect of octreotide and Somatostatin on the rise of pancreatic amylase in the serum and urine after ERCP and EST. Methods] Forty-two patients with hepatobiliary diseases were examined with ERCP, abdominal B -ultrasound and CT simultaneously. A total of seventy five cannulations were performed on 64 patients with hepatobilary diseases. Serum and urine amylase were checked in patients of 62 cannulations who had received octreotide and/or Somatostatin. Results] The diagnostic rate of abdominal B ultrasound was 26.20%, The diagnostic rate of CT was 66.70%, and the diagnostic rate of ERCP was 97.60%. EST was performed on 36 patients with hepatobiliary stones. Stones were removed from fourteen pa- tients with single common bile duct stones and nineteen patients with multple common bile duct calculi. Endoscopic drainage in eight patients is achieved by performing biliary sphincteretomy and placement of nasobiliary drain to effect irrigation. Haemorrhage, acute cholangitis, and acute pancreatitis developed respectively in two, one and two patients after ERCP and EST. Following ERCP and EST, serum and Urine amylase values were increased in 64.71% and 70.58% of patients in the control group. Serum and Urine amylase values were increased in 17.24% and 34.48% of patients in the octreotide group. Serum and Urine amylase values were increased in 18.75% and 25.00% of patients in the somatostatin group. Conclusion] The diagnostic value of ERCP is very high. EST is a relatively safe and effective procedure in treatment of common bile duct stone. The results obtained in our study seem to indicate that octreotide and somatostatin can prevent the increase in serum and urine amylase values, compared to control group, but no significant difference is observed in oetreotide group and the somatostatin group.