术前内镜下胆道内外引流的临床意义

目的：探讨术前内镜下胆道内外引流（ENBD）和／或ERBD）对梗阻性黄疸患者进行治疗和术前准备的临床意义。方法：根据病因将胆道梗阻病例33例分为良性组（21例），恶性组（12例）。33例患者实施急诊或择期引流的同时行胆道造影以明确诊断。结果；所有患者胆道均得到充分引流，急性胆管炎者胆道感染得以迅速控制，免于急诊手术；恶性组除2例晚期胰头癌患者仅行ERBD姑息治疗外，其余经ERBD或ENBD引流后，TB均降至40μmol/L以下，为手术创造了条件。全部行根治性手术，除1例出现肝残而胆瘘外，余无并发症发生，无手术死亡率。结论：术前ENBD和ERBD确有进一步的影像学诊断价值和微创及良好的胆道引流减压减黄效果，急诊床旁ENBD尤其对急性重症胆管炎及老年急性胆管炎的治疗具有特别重要的意义。

CHOICE OF THE OPPORTUNITY AND MOTHED OF OPERATION OFCHOLITITHASIVE PORTAL HYPERTENSION

Objective:The article sum up the treatment experience of 36 cases cholelithiasive portal hypertension in two hospital from 1989 to 1999.Cholelithiasive portal hypertension has different conception of portal hypertension clolelithiasis.There are very obvious different in pathogenesis,clinical diagnosis,therapy and prognosis.Cholelithiasis portal hypertension should be treated as severe disease.There are different method and result of operation in the different stage of the disease from cholelithiasis,hepatic fibrosis,biliary cirrhosis to portal hypertension.The patients of Chlid A liver function should be adopted radical operation and these of Child B and C should be adhered to the personnel therapeutic principle.The emphasis of therapy is cholelithiasis and narrowing down the scope of operation and trauma.If patients' liver function worse in a week after operation,they should be given highly attention and abundantly treatment.That somatostatin is used in operation can effectively reduce bleeding and that glucocorticiod is used after operation can benefit to the restore of liver function.