诊治性内镜下逆行胰胆管造影操作技巧及并发症分析

Handling skill of remedial ERCP and analysis of complication

目的应用内镜下逆行胰胆管造影(endoscopic retrograde pancreatocholangiography,ERCP)和内镜下括约肌切开术(endoscop sphincterotomy,EST)治疗胰胆管疾病,观察其疗效和并发症。方法经内镜下逆行胰胆管造影和内镜下括约肌切开术诊治胰胆管疾病432例,常规行ERCP检查,证实胆管内有结石后行EST。然后根据结石部位、大小和数目以及胆总管直径大小采取不同方法处理结石。结果内镜逆行性胰胆管造影诊断肝胆胰疾病432例,成功407例(94.2%);其中328例经内镜乳头括约肌切开术进行胆胰疾病治疗,成功308例(93.9%);发生并发症25例(5.8%),主要为急性胰腺炎、急性胆管炎和Oddi扩约肌切口渗血,未成功病例中6例手术治疗,其余均为非手术治疗治愈,无死亡病例。结论ERCP和EST诊治胆总管结石,安全,有效,病人痛苦小。

[Objective] To investigate the therapeutic effects of endoscopic retrograde pancreatocholangiography （ERCP） and endoscopic sphincterotomy （EST） for choledocholithiasis and analysis of complication, [Methods] 432 cases underwent ERCP to make the diagnosis of choledocholithiasis and the subsequent EST to remove the stones. The stones removed via varied approaches depending on the differrent situation in terms of site, diameter and number of stones and diameter of common bile duct, [Results] 432 cases pancreata-bile duct disease were diagnose by ERCP, EST was successfully performed in 328 cases, complete removal of stones achieved in 308 cases, Complications occurred in 25 cases including acute pancreatitis, acute cholangitis and staxis of Oddis sphincter incision. Failed cases underwent laparotomy and cured, The was no death, [Conclusion] Combination of ERCP and EST is safe, effective and less pain for choledocholithiasis,