经内镜胆道引流失败的原因及其对策

目的：探讨经内镜胆道引流术在临床上应用失败的原因及其防范对策。方法：应用OLYMPUS TJF－240十二脂肠镜行内镜胆道引流术，包括内镜鼻胆管引流术（endoscopic nasbiliary drainage,ENBD)，内镜胆道内置管引流术（endoscopic retrograde biliary drainage,ERBD)和内镜胆管金属支架术（endoscopic metal biliary endoprothesis,EMBE)对其中失败的病例进行总结，找出失败的原因及其防范对策。结果：148例内镜下胆道引流术，失败8例（不包括ERCP插管失败者）。其中ENBD失败5例，经调整鼻－胆管位置、更换鼻－胆管及重新ERCP插管均获得成功，ERBD失败1例，经努力仍未成功，改用PTCD；EMBE失败2例，其中1例经原金属支架通道再套置入另一根金属支架而成功，另1例，支架放置不到1月又出现胆道阻塞，经原金属支架通道再放放塑料支架而恢复通畅引流。结论：经内镜胆道引流失败时，应分析其原因，采取相应的对策，绝大多数失败是可以避免或补救的。

Fall Reasons and Countermeasures of Endoscopic Billiary Drainage

Objective:Disscuss the reasons and countermeasures of the endoscopic biliary drainage. Method:We use duodenal side viewing endoscope(Olympus TJF 240) to do the endoscopic biliary drainage,including endoscopic nasobiliary drainage(ENBD);endoscopic retrograde biliary drainange (ERBD) and endoscopic metal biliary endoprothesis (EMBE).We summarize the failed cases to find the reasons of failure and the countermeasure to decrease them.Results:In the 148 cases taken endoscopic libiary drainage,there are 8 failed cases (not including the cases of failing to taken endoscopic biliary drainage,there are 8 failed cases (not including the cases of failing to intubate into the nipple).There are 5 ENBD failed cases,we use some metheds to remedy (including to modulate the site of naso-biliary tube,to use a new naso-biliary tube and to take another ERCP).We use PTCD to remedy the ERBD failed cases.There are 2 EMBE failed cases,we replace a new methal protheisis in one case and a plasitic prothesis in the metal prothesis of the another case which is blockd by tumor tissue only 1 month after EMBE. Conclusions:When the endoscopic biliary drainage is failed,we should analyze the reasons,then to take some methods to rmedy.Mostly,the failures can be avoided and be remedied.