急诊ERCP治疗急性胆胰疾病51例临床分析

Clinical analysis of emergency ERCP in patients with acute biliary and pancreatic diseases:a report of 51 cases

目的探讨急诊ERCP在急性胆胰疾病中的临床应用价值。方法回顾分析2年间急诊ERCP治疗急性胆胰疾病51例的临床资料。根据病情行ERCP检查和放置鼻胆引流管(ENBD)或内镜下乳头括约肌切开术(EST)。对于乳头部结石嵌顿用针型刀剖开乳头,或根据病情进行网篮取石,EN-BD或胆管塑料支架(ERBS),观察分析其临床疗效、术后并发症的发生率和病死率。结果51例急诊ERCP中49例治疗成功,内镜治疗成功率96.1%。其中ERCP+ENBD 7例,占13.7%;ERCP+针刀剖开乳头+ENBD3例,占5.9%;ERCP+EST+取石+ENBD29例,占56.9%;ERCP+EST+ENBS5例,占9.8%;ERCP+ERBS5例,占9.8%。ERCP治疗后24 h内临床症状明显减轻,无消化道穿孔、急性重症胰腺炎及出血等并发症;2例失败后改开腹手术治疗,其中1例术后因AOSC致多器官衰竭(MOF)死亡。结论急诊ERCP诊治急性胆胰疾病操作简单、安全、有效,可作为首选治疗手段,尤其适用于急、危、重症患者,值得临床推广。

Objective To investigate the value of emergency ERCP in patients with acute biliary-pancreatic diseases. Methods Retrospective analysis was made on the clinical data of 51 patients with acute hiliary-pancreatic diseases who were treated by emergency ERCP during two years. According to patients＇ condition, the examination of ERCP plus endoscopic nasobiliary drainage （ENBD） or endoscopic sphincterotomy （ EST ） was performed. The papilla sphincter was slivered by needle knife in the circumstance of stone impaction in the papilla, or in certain conditions, the calculus was removed by net basket, then, ENBD and endoscopic retrograde biliary stent （ERBS） were undertaken. The therapeutic effect, rate of postoperative complications and mortality rate were observed. Results Of the 51 cases, emergency ERCP treatment was successful in 49 cases. The total success rate of endoscopic treatment was 96. 1%. Among the 49 cases,7 cases （13. 7% ） were treated with ERCP and ENBD, 3 cases （5. 9% ） were treated with ERCP, needle knife sliver of the papilla sphincter and ENBS;29 cases （56.9%） were treated with ERCP, calculus removal and ENBD; 5 cases （9. 8% ） were treated with ERCP, EST and ENBD; and 5 cases （9.8%） were treated with ERCP and ERBS. Clinical symptoms were obviously relieved within 24 h after ERCP treatment, and with no complications such as cnteral perforation, acute severe pancreatitis or hemorrhage. Of the 51 cases, 2 failure cases were treated with open operation ; 1 case died of postoperative multiple organ failure （ MOF ） due to acute obstructive suppurative cholangitis （ AOSC ）. Conclusions Emergency ERCP is simple, safe and effective in diagnosis and treatment of acute biliary-pancreatic diseases, which should be the treatment of first choice. ERCP is especially suitable for emergent, critical and severe patients. Emergency ERCP is worthy of widespread clinicaluse.