ERCP在合并心肌损害的胆总管结石中的治疗价值

Therapeutic value of ERCP in choledocholith complicated with cardiac damage

目的探讨ERCP在合并心肌损害的胆总管结石中的治疗价值。方法对本院2009年2月-2012年8月诊断为胆总管结石的38例患者,分为A、B两组,A组为合并心肌损害的胆总管结石的19例患者,B组为不合并心肌损害的胆总管结石的19例患者。比较两组ERCP前后及组间心肌酶谱的差异,并比较两组行ERCP后的并发症情况。结果两组患者均成功行ERCP,术前A组患者AST、LDH、CK、CK-MB较B组明显升高(P<0.05),术后A组心肌酶AST、LDH、CK、CK-MB较术前明显下降(P<0.05),但仍稍高于B组,差异无统计学意义(P>0.05),两组并发症无明显差异。结论 ERCP通过EST、塑料支架置入或者鼻胆管引流等能在短时间内解除胆道梗阻,祛除心肌损害的病因,快速改善心肌功能,是合并心肌损害的胆总管结石的相对安全有效的治疗方法。

Objective To evaluate the therapeutic value of ERCP in choledocholith complicated with cardiac dam age. Methods 38 cases of eholedocholith in our hospital from Feb. 2009 to Aug. 2012 were divided into group A and group B, 19 cases of choledoeholith complicated with cardiac damage were in groups A, 19 cases of choledoeholith with out cardiac damage were in group B. The difference of the myocardial enzyme spectrum in two groups before and after ERCP were compared. Besides, the complication of ERCP was compared. Results ERCP was successfully performed in two groups of patients. Preoperative the myocardial enzyme spectrum AST, LDH, CK, CK-MB in group A were obvi ously higher than those in group B （P 〈 0.05）. Postoperative the AST, LDH, CK, CK-MB in group A were obviously lower than the preoperative （P 〈 0.05） , but they were still higher than those in group B, there was no statistical signifi cance （P 〉0.05）. The complication of ERCP in two groups had no significant difference. Conclusion ERCP could relieve obstruction of biliary tract, dispel the pathogenyin of cardiac damage, improve function of myocardium in short time through EST and plastic biliary stent or endoscopic nose biliary drainage. ERCP is a safe and effective treatment method of eholedoeholith complicated with cardiac damage.