68例恶性梗阻性黄疸患者ERCP诊治的分析

Analysis on diagnosis and treatment of ERCP for 68 patients with malignant obstructive jaundice

目的探讨经内镜逆行胰胆管造影(ERCP)及其相关技术在恶性梗阻性黄疸患者诊断和治疗中的作用。方法回顾性分析68例恶性梗阻性黄疸患者的ERCP诊断情况,以及ERCP相关性治疗,包括内镜下鼻胆管引流(ENBD)、内镜下胆管金属支架引流术(EMBD)、塑料支架引流术(ERBD)、超声引导下经皮肝穿刺胆道引流术(PTCD)联合ERCP支架植入术的应用情况,并对患者的预后及并发症进行总结分析。结果 68例患者均经ERCP检查,共成功发现病变显影54例(79.4%),其中壶腹癌(16/18)、乳头癌(10/12)、胆管下段癌(8/10)、胆囊癌(5/5)、肝癌侵犯胆管(2/2)肝门部胆管癌(6/11)、胰腺癌(6/8)。术后7 d胆红素及ALP水平较术前均明显下降,大部分患者症状明显缓解。术后并发急性胰腺炎8例(14.8%),电解质紊乱9例(16.7%),并发消化道出血3例。49例接受为期6个月的随访,其中死亡12例(24.5%)。结论 ERCP及其相关治疗手段能够减轻黄疸,缓解症状,提高生活质量,延长生存期,是姑息性治疗恶性梗阻性黄疸的重要方法。

Objective To explore the effects of endoscopic retrograde cholangiopancreato-graphy （ERCP） and related treatment tech- niques in diagnosis and treatment for patients with malignant obstructive jaundice. Methods The diagnosis information of 68 patients with malignant obstructive jaundice and treatment status of ENBD, EMBD, ERBD, PTCD combined with ERCP were retrospectively analyzed. Re- suits There were 54 patients imaged in 68 cases by ERCP（79.4% ） ,including ampullary carcinoma（16/18） ,nipple carcinoma（ 10/12）, low segment bile duct cancer（8/12）, carcinoma of gallbladder（5~5 ） ,bile duct offended by liver cancer（2/2）, cholangioearcinoma in hepatic hilum（6/11 ） and pancreatic cancer （6/8）. Seven days after treatment, the level of bilirubin and ALP were obviously decreased, and the symptoms of most patients were relieved. 8 patients （ 14.8% ） complicated with acute panereatitis, 9 patients （ 16.7% ） with electrolyte dis- turbances ,3 cases with alimentary tract hemorrhage. There were 12 patients （24.5%） died among 49 patients with 6 months＇ follow-up. Conclusion ERCP and related treatment methods can relieve jaundice and alleviate symptoms, elevate the quality of life, extend life span for the patients with malignant obstructive jaundice, which is an important method for palliative therapy of malignant obstructive jaundice.