胰头结核并发梗阻性黄疸的内镜胆道塑料支架置入治疗

The treatment of endoscopic retrograde bilioduodenal drainage in obstructive jaundice complicated by pancreatic tuberculosis

目的探讨内镜下胆道塑料支架置入治疗胰头结核并发梗阻性黄疸的疗效和经验。方法回顾性分析应用内镜置入胆道塑料支架的16例胰头结核并发梗阻性黄疸患者的治疗情况和效果。结果所有患者(100%,16/16)均在内镜下成功安置胆道塑料支架,平均操作时间11.6min。术后腹痛缓解(中位时间4.6d),黄疸明显减轻(血清胆红素中位完全恢复时间28d),胰头包块缩小50%的中位时间65.8d;胰头形态完全恢复时间中位时间169.2d,塑料支架平均放置时间102.6d。抗结核药物治疗1年后随访,所有患者痊愈。并发症情况,1例(6.25%,1/16)安置胆道塑料支架后第2天出现十二指肠乳头切开处出血,内镜下电凝止血后好转;3例(18.75%,3/16)分别在安置后26、61及69d发生塑料支架堵塞,对症治疗后恢复通畅引流。结论内镜下胆道塑料支架置入联合抗结核药物治疗胰头结核并发梗阻性黄疸是一种安全有效微创伤的治疗方法。

[Objective] To explore the therapeutic efficacy and operation experience of endoscopic retrograde bilioduodenal drainage（ERBD） for obstructive jaundice complicated by caput pancreatic tuberculosis.[Methods] The clinical data of 16 patients with obstructive jaundice complicated by caput pancreatic tuberculosis were selected as the object of this study.A retrospective analysis was done on therapy conditions and effects of ERBD and antituberculosis drugs treatments.[Results] All 16 patients were placed biliary plastic stent with average operation time in 11.6 minutes.The average time of abdominal pain release is 4.6 d,the recovery time of serum bilirubin is 28 d and the shape of caput pancreatis is 169.2 d,the average placing time of biliary plastic stent is 102.6 d.The follow-up visits indicated all patients were healing by continue antituberculosis drugs treatment in 1 years.The incidence of complication is as low as 25.0% with 4 cases after operations（the dissection point of duodenal papilla hemorrhage：1 case/6.25%,the obstruction of biliary plastic stent：3 cases/18.75%）,and all healed by conservative treatments.[Conclusion] The treatment of endoscopic retrograde bilioduodenal drainage and antituberculosis drugs is safe and effective method in obstructive jaundice complicated by pancreatic tuberculosis.