ERCP对225例梗阻性黄疸的诊断分析

探讨ＥＲＣＰ对梗阻性黄疸的病因诊断和并发症的防治。对临床诊断梗阻性黄疸的２２５例患者做ＥＲＣＰ检查，发现１．梗阻性黄疸常见病因为肿瘤和总胆管结石。２．５０岁以上患者肿瘤较常见，主要为总胆管癌、壶腹周围癌和胰腺癌。３．对总胆管结石的诊断，ＥＲＣＰ较腹Ｂ超准确，诊断准确率分别为９４．６％和２５．９％，二者比较差异极显著（Ｐ＜０．０１）。４．化脓性胆管炎是ＥＲＣＰ最严重的并发症，对黄疸严重的患者，采取（１）先做ＰＴＣ；（２）把６０％泛影葡胺稀释为３０％；（３）在造影剂中加入庆大霉素。可明显减少并发症。因此，ＥＲＣＰ诊断梗阻性黄疸是一种既准确又安全的方法。

Diagnosis and Analysis of 225 cases of Obstructive Jaundice Examined by ERCP

The purpose of this study was to observe the cause diagnosis of obstructive jaundice and how to present from complication.The result of examination by ERCP of 225 patients who were diagnosed as obstructive jaundice shows that major causes are tumor and common bile duct stone.For patient older than 50,tumor is more commonly discovered cause,most are common bile duct carcinoma,periampullary carcinoma and carcinoma of pancrease.The diagnosis of common bile duct stone,ERCP is superior to ultrasonography,causes of the obstrution confirmed rightly were 94 6% and 25 9%, the difference was very signaficant ( P <0 01).Cholangitis sepsis is the most serious complication of ERCP.We should present the patients with serious jaundice frow cholangitis sepsis,firstly,to do PTC for patients,secondly,to dilute the 60% solutions of meglumine diatrizoate to 30%,thirdly,to add gentamycine to contrast medium.These measures may greatly decrease the death rate.For this reason,ERCP was a accurate and also safe method on obstructive jaundice.