鼻胆管引流对于ERCP术后并发症的防治

目的探讨内镜下鼻胆管引流术预防和治疗ERCP术后胰腺炎、胆道感染、穿孔等并发症的效果。方法回顾分析2003年5月至2005年5月间868例ERCP患者的临床资料,其中657例于内镜治疗后行置鼻胆管引流,211例患者未行鼻胆管引流。在行鼻胆管引流的患者中,胆道结石为354例,胆道恶性梗阻为128例,胆总管扩张为56例,胆总管囊肿为17例,缩窄性乳头炎为34例,ERCP未见明显异常68例;未行鼻胆管或内支架引流的患者中,胆总管结石116例,胆总管扩张51例,胆总管囊肿3例,缩窄性乳头炎11例,ERCP未见明显异常30例。结果两组术后急性胰腺炎发生率分别为1.4%和3.8%(P>0.05),但引流组均为轻症胰腺炎,而非引流组50%为重症胰腺炎。急性胆管炎的发生率分别为0.5%和2%(P<0.05),而且非引流组中40%出现AOSC,需手术治疗。胰管显影率分别为13%和14%(P>0.05);穿孔各2例(0.3%vs0.9%),其中未行鼻胆管引流组中1例经手术后痊愈,其余均经非手术治疗痊愈。结论内镜下鼻胆管引流能有效预防和治疗部分ERCP并发症。

Prevention and treatment of endoscopic nasal biliary drainage for post-ERCP complications

Objective To investigate the preventive effects of endoscopic nasal biliary drainage on post-ERCP complications such as pancreatitis,cholangitis and perforation.Methods Totally 868 cases of ERCP were collected during 5,2003-5,2005.Among them 657 cases had nasal biliary drainage after endoscopic procedure and the other 211 case hadn't.For the drainage group,there were 354 cases of biliary stone,128 cases of malignant biliary obstruction,56 cases of simple dilatation of common bile duct,17 cases of biliary cyst,34 cases of strictured papilla and 68 cases without abnormal change.And there were 116 cases of biliary stone,51 cases of simple dilatation of common bile duct,3 cases of biliary cyst, 11 cases of strictured papilla and 30 cases without abnormal change for the undrainage group.Results The occurrence rate of acute pancreatitis after ERCP procedures in two groups was 1.4% and 3.8%(P>0.05) respectively,but all patients in drainage group were mild pancreatitis while 50% of un-drainage group were severe pancreatitis.Acute cholangitis was more often in un-drainage group than drainage group(2% vs 0.5%,P<0.05).Also 40% of patients in un-drainage group were AOSC that needed surgical intervention. Pancratography was 13% and 14%,respectively(P>0.05).Perforation was 0.3% and 0.9%,respectively(P>0.05).One of un-drainage group needed operation while others were cured conservatively.Conclusion Endoscopic nasal biliary drainage can KG0.2mm]prevent KG0.2mm]and KG0.2mm]treat KG0.2mm]some KG0.2mm]of KG0.2mm]post-ERCP complications effectively.