内镜治疗肝硬化合并胆总管结石的临床研究

Endoscopic treatment of choledocholithiasis in patients with decompensated cirrhosis

目的探讨内镜治疗肝硬化合并胆总管结石的疗效及安全性。方法104例肝硬化合并胆总管结石患者行内镜治疗，对比术前、术后2周肝功能Child．Pugh分级和终末期肝病积分（MELD积分），记录并发症发生情况及死亡病例数。结果104例患者中96例（92．3％）完全取出结石，8例（7．7％）未取出结石者放置支架内引流。术后2周MELD积分为（10．1±6．3）分，明显低于术前的（11．9±6．2）分（t=2．22，P〈0．05）；术后2周肝功能Child—Pugh分级例数比（A级／B缈C级）为40／52／12，明显优于术前的28／52／24（X2=6．12，P〈0．05）。内镜治疗过程中无一例穿孔，发生术后消化道出血9例、术后胰腺炎8例；住院期间无死亡病例，出院后3个月内有2例（8．3％）Child—Pugh分级C级患者死亡。结论内镜治疗肝硬化合并胆总管结石有较好疗效，采取有效的预防和止血等措施后是安全可行的。

Objective To explore the safety and efficacy of endoscopic treatment for choledocholithiasis in patients with decompensated cirrhosis. Methods A total of 104 cases of choledocholithiasis with decompensated cirrhosis were treated by ERCP in our hospital between January 2001 and March 2011. Child- Pugh grading and model for end stage liver diseases （MELD） were investigated pre-ERCP and 2 weeks post- ERCP. Complication and mortality during the follow-up were recorded. Results The success rates of complete stone retrieval was 92.3% （96/104） , and plastic stent was placed in other 8. Major complications included post-ERCP bleeding in 9 cases （8.7%） and pancreatitis in 8 （7. 7% ）. MELD score valuated 2 weeks after ERCP （ 10. 1 ± 6. 3 ） was significantly lower than that of pre-ERCP （ 11.9 ± 6. 2, t = 2. 22, P 〈 0. 05）. The Child-Pugh grading before ERCP of 104 patients were 28 in grade A （26. 9% ） , 52 in grade B （50. 0% ） and 24 in grade C （23.1%）, which was significantly different from those of 2 weeks after ERCP （40/52/12）. No death was recorded during hospital stay for choledocholithiasis, and 2 patients of Child- Pugh grade C died in 3 months after discharge. Conclusion ERCP is an effective method for choledocholithiasis in patients with decompensated cirrhosis. The main severe complication was post-ERCP bleeding. Those patients with deeompensated cirrhosis would benefit from ERCP if we took effective measures.