胆道术后良性胆道狭窄ERCP治疗效果

Endoscopic management of benign postoperative bile duct strictures

目的探讨术后胆道狭窄内镜治疗的效果。方法对13例术后良性胆道狭窄患者使用内镜行乳头肌切开、狭窄段扩张、鼻胆管引流、内支架等进行治疗。结果11例患者(84.6%)成功放置引流,其中1例早期导丝不能通过狭窄段,改经皮肝穿刺胆管扩张后再放置内支架成功;10例(76.9%)患者单纯使用内镜治疗治愈,均未见胆管狭窄复发,1例内支架尚未拔除。无内镜相关死亡。结论内镜治疗在术后胆道良性狭窄的患者中有效,其长期有效率与外科相当,因无相关死亡率,将成为其首选治疗方式。

[Objective] To evaluate the effectiveness of endoscopic retrograde cholangiopancreatography（ERCP） as a treatment for benign postoperative bile duct strictures. [Methods] 13 cases of postoperative bile duct strictures with attempted endoscopic treatment were reviewed. The treatment consisted of endoscopic sphineterotorny, stricture dilation, nosobiliary catheter drainage and stent insertion. [Results ] Successful stent or nosobiliary catheter insertion was achieved in 11/13（84.6%） of patients, including combined percutaneous procedure was required in one patient because of failure to pass a guidewire through the stricture after endoscopic retrograde eholangiography （ERC）. One patient was cured by sole biliary dilation through endoscopic route. Both endoscopic and pereutaneous procedures were unsuccessful in one case of tight hilar stricture. This patient was referred to surgery and underwent hepaticojejunostomy. Ten patients（76.9%） were cured by endoscopy alone, one was cured by combining endoscopic with percutaneous procedures. No procedure-related mortality was observed. [Conclusion] Endoscopy is an effective measure in treatment of benign postoperative bile duct strictures. It is comparable to success rates reported after surgical treatment in long-term. It is suggested that endoscopic approach as the first treatment for postoperative bile duct strictures.