诊断性ERCP在胆胰疾病中应用价值

目的 探讨ERCP对各种胆胰疾病的诊断及治疗价值.方法 回顾性分析该院肝胆胰外科2007年3月～2010年12月完成的ERCP 1 003例,对其中175例(17.45％)常规影像学检查未能确定诊断而经ERCP进行诊断和治疗的病例进行总结分析.镜下可疑乳头或壶腹肿瘤局部活检,确诊后部分病人根治性手术.选择性胆胰管造影,动态观察胆胰管扩张情况并注意结石及占位特征及胆胰管造影剂排空情况,根据ERCP诊断结果采取相应内镜下治疗措施.结果 175例ERCP检查中,成功率98.29％(172/175).均经ERCP检查确定病因和/或定位诊断.61例胆总管结石行EST切开取石或碎石,其中60例胆总管结石及2例胆道蛔虫症一次取出成功；49例十二指肠乳头、胆管下段炎性狭窄行EST; 33例ERCP诊断十二指肠乳头壶腹癌中15例行外科手术治疗；10例十二指肠乳头壶腹癌、6例胆管癌及胰腺癌、2例胆管良性狭窄及2例硬化性胆管炎行经内镜胆管内引流术(ERBD);15例医源性胆管损伤中5例胆瘘病人经ENBD后痊愈,10例经胆肠吻合术后痊愈.无严重并发症.结论 ERCP对部分胆胰疾病的诊断仍然有不可替代的作用,诊断的同时加做内镜下治疗是ERCP的突出优势,但要严格掌握适应证.

Value of diagnosis endoscopic retrograde cholangiopancreatography for cholangiopancreatic diseases

【Objective】 To evaluate value of the diagnosis and treatment of endoscopic retrograde cholangiopancreatography(ERCP) for various cholangiopancreatic diseases.【Methods】 The cases of cholangiopancreatic diseases treated and diagnosed with ERCP were analyzed in our department from March 2007 to December 2010.All of the 175 cases did not receive accurate diagnosis by B type ultrasonography,computed tomography(CT) and magnetic resonance cholangiopancreatography(MRCP).Suspicious papillary or ampulla tumor was biopsied,radical surgery was performed after pathological positive diagnosis.Selective cholangiopancreatography and dynamic observation of bile duct dilatation and stones,characteristics of mass and emptying of contrast agent,endoscopic therapy measures were taken based on ERCP diagnosis results.【Results】 Of 175 cases,the success rate of endoscopic examination was 98.29%(172/175).61 cases of common bile duct stones and 49 cases with papilla and lower bile duct inflammatory stricture were cured with EST;15 cases were performed surgery in 33 cases of duodenal ampullary carcinoma;10 cases of duodenal papilla and ampullary carcinoma,6 cases of cholangiocarcinoma and pancreatic cancer,2 cases of benign bile duct stricture and 2 cases of sclerosing cholangitis got ERBD;15 cases were diagnosised iatrogenic bile duct injury in which 5 cases of fistula patients cured by ENBD,10 patients cured with biliary-enteric anastomosis.Severe complications did not occur in these cases.【Conclusion】 ERCP on the diagnosis of the part of biliary and pancreatic disease is still irreplaceable,diagnosis made at the same time plus ERCP endoscopic therapy is the outstanding advantage,but the indications should be strictly controlled.