ERCP在手术后胆漏中的诊治作用

目的探讨ERCP对肝胆术后胆漏诊断及治疗作用。方法对2003年1月至2008年12月接受ERCP诊治的120例肝胆术后胆漏患者进行回顾性分析。结果120例胆漏患者中，诊断肝外胆漏（Ⅰ型）71例、肝内胆管漏（Ⅱ型）39例、胆囊管漏（Ⅲ型）10例。其中76例行内镜下鼻胆管引流术（ENBD），35例行胆管内支架引流术（ERBD），3例行ERBD＋ENBD，2例单纯行经内镜乳头括约肌切开术（EST），1例放置可回收金属支架行金属支架引流（EMBE），3例内镜治疗失败。共完整随访98例，占81．7％（98／120），其中有效治愈胆漏85例，有效治愈率为86．7％（85／98），平均胆漏愈合时问为（18．2±7．0）d。各型胆漏中，Ⅲ型胆漏有效治愈率最高，为100．0％，且该型胆漏愈合时间最短，为（8．2±3．5）d；在Ⅰ型和Ⅱ型胆漏中，对应非肝移植术后胆漏有效治愈率明显高于肝移植术后（P〈0．01），且愈合时间明显变短（P〈0．01）。结论ERCP是诊治肝胆术后胆漏的一种安全、有效的手段，具有重要的临床价值，可作为肝胆术后胆漏诊治的首选方法，对于Ⅲ型胆漏治疗效果尤佳。

Endoscopic retrograde cholangiopancreatography in managements of postoperative biliary leakage

Objective To evaluate the diagnostic and therapeutic value of endoscopic retrograde cholangiopancreatography (ERCP) for postoperative biliary leakage. Methods Data of 120 patients who developed biliary leakage after hepatobiliary operations and underwent ERCP from January 2003 to December 2008 were retrospectively reviewed. Results There were 71 cases of extra-hepatic biliary leakage (type I ) , 39 intra-hepatic biliary leakage (type II ) and 10 cystic duct leakage (type HI) , among which endoscopic nasobiliary drainage ( ENBD) was performed in 76 cases, endoscopic retrograde biliary stent drainage (ERBD) in 35, ERBD plus ENBD in 3, endoscopic sphincterotomy (EST) in 2, endoscopic metal biliary endoprothesis (EMBE) in 1 and ERCP related procedures failed in 3 patients. A total of 98 (81. 7% ) patients were successfully followed up. Bile leakage was completely controlled in 85 patients (86. 7% ) at a mean time of 18. 2 ±7. 0 d. Leakage of type M had the highest cure rate of 100% and the shortest cure time of 8. 2 ± 3. 5 d. For leakage of type I and II developed after non-liver transplantation operations, the success rate and cure time were significantly better than those after liver transplantation ( P < 0. 01 ). Conclusion ERCP is safe and effective for the diagnosis and treatment of biliary leakage after hepatobiliary operations , and can be the first choice of managements, especially in biliary leakage of type III.