ERCP在不明原因肝外阻塞性黄疸的临床应用

Clinical application of ERCP in the diagnosis of unexplained extrahepatic obstructive jaundice

目的探讨内镜逆行胰胆管造影(ERCP)在经常规检查不明原因肝外阻塞性黄疸的临床应用价值。方法收集经B超、CT和/或MRCP检查诊断不明原因胆胰疾病或肝外胆管梗阻病人45例,男28例,女17例,年龄21～80岁,均行ERCP术。结果 45例病人行ERCP术,其中42例诊断为胆道微结石(Bi1iary microlithiasis,BML),42例均行乳头扩张术/EST+胆道取石术;3例为胆总管下端炎性狭窄而行胆道内支架植入术;1例ERCP取石术后并发轻症胰腺炎,经内科保守治疗后痊愈,1例因腹痛再发行胆囊切除术,其余患者经ERCP治疗后腹痛、黄疸均缓解。结论 BML是不明原因肝外阻塞性黄疸的主要原因,ERCP是不明原因肝外阻塞性黄疸安全、有效的诊断及治疗手段。

Objective To valuate the clinical application of endoscopic retrograde cholangiopancre- atography （ERCP） to the patients with unexplained extrahepatic obstructive jaundice after routine diagnostic approaches. Methods Forty-five patients consisting of 28 males and 17 females, aged 21 to 80 years old, en- rolled for ERCP to determine the causes of pancreatic disease as well as extrahepatic bile duct obstruction which could not be figured out via ultrasonography, CT and/or MRCP. Results After ERCP, 42 of 45 patients were diagnosed as biliary microlithiasis and were treated by endoscopic sphincterotomy （EST） technique to re- move biliary microlithiasis. The patients with lower common bile tract were treated with endoscopic retrograde biliary drainage （ERBD）. Together, all patients were rapidly relieved from abdominal pain and jaundice except two cases. One of them suffered from post-operative complication of mild pancreatitis but cured by conserva- tive treatment, another one developed recurrent abdominal pain and then received cholecystectomy. Conclu- sion Our findings indicate that biliary microlithiasis is the main cause of unexplained extrahepatic obstructive jaundice. ERCP is a safe and reliable method for diagnosis and therapy of extrahepatic obstructive jaundice.