胆管损伤的内镜介入治疗

Endoscopic intervention therapy for bile duct injury

目的探讨ERCP对医源性胆管损伤的诊疗价值。方法通过对19例医源性胆管损伤行ERCP检查,分析判断胆管损伤部位、程度,根据需要进行内镜下引流或取石治疗。结果胆管中断5例;胆囊管残端瘘8例(单纯6例,合并胆总管末段结石2例);胆管不同程度狭窄8例。有14例接受1～6次ERCP治疗。8例胆瘘患者经ENBD或ERBD引流,胆瘘治愈,但有2例半年后出现胆管狭窄。8例胆管狭窄患者,经扩张、支架置入治疗,7例治愈,1例需手术治疗。结论ERCP对医源性胆管损伤具有重要的诊治价值。

[ Objective ] To study the clinical value of endoscopic retrograde cholangiopancreatography （ERCP） in the diagnosis and treatment of postoperative bile duct injury. [ Methods ] Nineteen patients were examined with ERCP for postoperative bile duct injury, further therapeutic approaches were determined according to ERCP examina- tion. [Results] ERCP revealed 5 cases with complete interruption of bile duct, 8 cases with cystic duct fistula （including 6 cases with single fistula and 2 cases fistula companied by choledocholith at the terminal part of common bile duct）, and 8 cases with biliary duct stenosis. 14 cases received 1-6 times of therapeutic ERCP. 8 patients with biliary fistula had the drainage of ENBD or ERBD, and biliary fistula recovered; however, 2 of them had biliary stenosis half year later. 8 cases with bile duct stenosis had the dilation and ERBD, 7 cases recovered with 1 case failed. [ Conclusion ] ERCP has an important value in the diagnosis and treatment of postoperative bile duct injury.