内镜治疗肝外胆管良性狭窄29例

Duodenoscopic treatment of benign extrahepatic biliary stricture:an analysis of 29 cases

目的:探讨内镜在肝外胆管良性狭窄治疗中的作用.方法:回顾性分析29例因梗阻性黄疸入院,均经CT或MRI及实验室检查及其病史确诊为胆管良性狭窄患者临床资料.将肝外胆管狭窄分类比照Bismuth标准分为3型,并评价患者行十二指肠镜乳头肌切开术(EST)或行胆管内支架引流术(ERBD)的治疗效果.结果:29例患者经EST或ERBD治疗,有效率为96.55%.随访患者28例,其中行EST治疗4例,均未复发;放置ERBD24例,8例6mo内复发、8例再狭窄患者中4例为慢性胰腺炎,2例为有胆囊切除史者,占该组11.11%(2/18);其余8例中5例为单支架置入者.结论:肝外胆管良性狭窄的内镜下治疗安全有效,其治疗效果与狭窄的病因和部位有关;狭窄部位长时间、多支架置入,可以减少术后再狭窄率.

AIM： To evaluate the efficacy of duodenoscopic treatment for benign extrahepatic biliary stricture. METHODS： The clinical data for 29 patients, who were hospitalized due to obstructive jaundice and diagnosed as benign extrahepatic biliary stricture based on computed tomography （CT） or magnetic resonance imaging （MRI） findings, laboratory test results and medical history, were analyzed retrospectively. Extrahepatic biliary strictures were graded from type 1 to type 3 according to the Bismuth classification. The efficacy of endoscopic sphincterotomy （EST） or endoscopic retrograde biliary drainage （ERBD） in these patients was evaluated. RESULTS： Twenty-nine patients underwent EST or ERBD, and the response rate was 96.55%.Of 28 patients followed up, 4 were cured after EST and showed no recurrence, and 24 under-went ERBD, of which 8 showed recurrence in half a year, 8 developed biliary restenosis （of which 4 had chronic pancreatitis, and 2 under-went previous resection of the gallbladder）, and 8 showed a good response （of which 5 under-went placement of a single stent）. CONCLUSION： Duodenoscopic treatment of benign extrahepatic biliary stricture is safe and effective. The efficacy of duodenoscopic treatment for benign extrahepatic biliary stricture is associated with the cause and site of strictures. Long-term placement of multiple stents can reduce the occurrence of biliary restenosis after surgery.