内镜下逆行胰胆管造影术对医源性胆道损伤的诊断与治疗

Diagnosis and treatment of iatrogenic biliary injury by endoscopic retrograde cholangio-pancreatography (ERCP)

目的探讨内镜下逆行胰胆管造影术(endoscopic retrograde cholangio-pancreatography,ERCP)对医源性胆道损伤的诊断与治疗价值。方法行常规胆管造影,透视下发现胆管梗阻时,如发现胆管完全梗阻或已中断,即停止操作;如发现胆管狭窄,采用扩张探条和柱状扩张气囊行狭窄段扩张,再放置塑料内置管。发现造影剂外溢时,如为肝外胆管漏,引流管置于肝内胆管,如为肝内胆管漏,则置于接近漏口的胆管中。发现胆管结石时,如条件许可则行括约肌切开取石。结果18例患者中13例成功接受内镜下治疗,其中9例患者疗效满意,避免了再次手术,疗效满意率69.2%,其余9例患者,除1例病情恶化外均接受手术治疗。该组未发生与内镜操作有关的并发症和死亡。结论对于手术造成的胆道损伤,ERCP不仅具有定性和定位的诊断意义,而且具有一定的治疗作用,多数的胆漏患者和部分胆管狭窄患者可通过内镜治疗痊愈,避免了再次手术的创伤。

[Objective] To investigate the value of ERCP in the diagnosis and treatment of iaotrogenic biliary injury. [Method] Routine cholanqiography was done. Biliary obstruction was observed by x-ray examination. If the bile duct was completely obstructed or broken off, the operation would be stopped. If there was a bile duct stenosis, dilation probe and balloon were used to expand the striature, then a plastic inner tube was placed. When the radiocontrast overbrimed, conductive tube was placed into introhepatic duct if there was extrahepatic leak;when introhepatic biliary leak existed, it would be placed into the duct near the leak. When there was cholithiasis, the stones were taken out by sphicterotomy if permitted. [Results] 13 of 18 patients received therapeutic endoscopy successfully. 9 of 18 the patients avoided once more operation and got satisfied result. The successful rate was 69.2%. Others got operation except one whose state had become worse. There were no endoscopic operation related complications and mortality. [Conclusion] For iatrogenic bile duct injury, ERCP has not only the diagnostic value of location and definition but also the treatment function to some extent. Most of bile duct leak patients and part of biliary stricture ones can recover by therapeutic endoscopy. So the injury induced by once more operation is avoided.