注气造影--一种肝门部胆管癌ERCP检查治疗的新方法(附随机对照临床试验)

Visualization with inflation:A new method of ERCP for examination and treatment of hilar cholangiocarcinoma,with a randomized controlled clinical study

目的探讨经十二指肠镜行肝门部胆管癌(HCC)造影的新方法。方法选择CT、磁共振胆管胰腺造影术(MRCP)诊断明确的HCC患者36例,随机分为注气造影组和碘造影剂组,每组18例。两组均正常插入十二指肠镜,找到十二指肠乳头,在透视观察下,利用导丝技术经乳头插管成功后,顺导丝送导管入左(或右)肝内胆管,行造影观察。碘造影剂组按常规注入35%安碘醇,调整导丝至左(或右)肝内胆管主干,置入7Fr或8.5Fr一体式塑料内支架,抽出造影剂后释放支架;注气造影组注入空气,透视下观察,调整导丝至左(或右)肝内胆管主干,置入7Fr或8.5Fr塑料内支架,抽出注入气体后释放支架。重新插管至另一侧肝内胆管,分别注入碘造影剂或空气透视观察后置入8.5Fr塑料内支架。术后常规给予抗感染及对症支持治疗,观察黄疸消退、发热、腹痛等情况。结果36例HCC患者行内镜逆行胆总管胰腺造影术(ERCP)塑料内支架置入术均一次成功。碘造影剂组中6例术后出现发热,其中3例黄疸未消退患者再次行ERCP,调整支架引流位置,引流出脓性胆汁后体温降至正常、黄疸消退,另3例发热患者经抗感染治疗后体温降至正常、黄疸消退。注气造影组中未出现术后发热和化脓性胆管炎病例,黄疸消退理想。结论经十二指肠镜注气造影并支架引流治疗HCC更加安全,疗效满意。

Objective To explore a new method of endoscopic retrograde cholangiopancreavography （ERCP） for examination and treatment of hilar cholangiocarcinoma with duodenoseopy. Methods Thirty-six patients diagnosed as hilar cholangiocarcinoma by CT and magnetic resonance cholangiopancreatography （MRCP） were selected and divided randomly into air inflation group （AG, n= 18） and diodone group （DG, n = 18）. Duodenoscope was normally inserted in both groups to locate the duodenal papilla. Cannulation was performed successfully into the common bile duct via the papilla with the guide-wire technology under DSA, and the tube was then sent into the left （or right） intrahepatic bile duct. Patients in DG group were injected with 35% diodone with routine method. Guide wire was adjusted into the stem of the left （or right） intrahepatic bile duct, and 7Fr or 8. 5Fr plastic stent was then inserted. The diodone was removed after the stent was drawn out. The same manipulation was performed in the patients of AG group. Tube was cannulated again into the other intrahepatic bile duct, and then 8. 5Fr plastic stent was inserted with the aid of DSA, and diodone or air was injected in different groups. Anti-infection and supportive treatment was given routinely after the operation. Symptoms such as jaundice, fever and abdominal pain were observed and close attention was paid. Results All the 36 patients were successfully operated in one performance. Six patients in DG group were found to have fever after operation. In 3 patients with persistent jaundice were re-operated. After the position of the stent was adjusted and the purulent bile was drained, the body temperature dropped to normal and jaundice was also relieved. The body temperature of other 3 patients also dropped to normal after anti-infection therapy, and jaundice faded too. After the operation, none of the patients in AG group had fever or suppurative cholangitis, and jaundice in all patients faded smoothly. Conclusion Inflation during ERCP for the treatment of hilar cholangiocarcinoma by duodenoscopy is safe and effective.