诊断与治疗性胰胆管造影在胆管损伤中的临床应用

目的探讨胰胆管引流（ERCP）在胆管损伤诊断中的作用及其临床应用疗效。方法总结1999年3月至2004年3月收治的31例胆管损伤患者，行诊断性ERCP，选择有内镜治疗价值者作为实施对象，行乳头肌切开术（EST）、鼻胆管引流、塑料支架支撑引流等内镜治疗。结果31例胆管损伤中，胆总管横断或结扎3例，胆管狭窄13例，胆瘘15例，22例（34次）接受内镜治疗，占71％。13例胆管狭窄中，有7例行塑料支架支撑治疗维持8～20个月，4例疗效满意，3例疗效欠佳；15例胆瘘患者行EST、鼻胆管引流，13例胆瘘愈合，2例无效，其中7例因胆管狭窄或有狭窄倾向置入塑料支架支撑维持4～12个月。6例发生术后高淀粉酶血症。结论ERCP对胆管损伤有定性和定位诊断意义，多数胆瘘和部分胆管狭窄患者通过内镜治疗获得痊愈，早期内镜治疗可简化治疗方案，避免再次手术。

Clinic application of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography in bile duct injury

Objective To evaluate the role of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography(ERCP)in bile duct injury. Methods Thirty-one patients with bile duct injury from March 1999 to March 2004 were managed by ERCP. Patients with indications of endoscopic therapy were treated by endoscopic sphincterectomy(EST)and plastic stent drainage. Results Twenty-two of 31 patients with bile duct injury received endoscopic therapy . The patients included 3 cases of common bile duct transection or ligation, 13 cases of bile duct stricture, and 15 cases of bile leakage. Seven of 13 patiens with bile duct stricture received plastic stent therapy, followed for 8-20 months, 4 cases with satisfaction and 3 cases with poor outcome. Fifteen cases of bile leakage accepted EST and endoscopic nasalbiliary drainage(ENBD) , in the first time,13 cases resulted in healing of the leakage,2 cases were of no effect. Seven cases of bile duct stricture were treated with plastic stent, maintaining for 4-12 months. No procedure related complications. Conclclusions ERCP is helpful not only for diagnosing and localizing localizing bile duct injury, but also for treating it in most of patients with relatively good and safe results.