超声内镜治疗胆道远端炎性狭窄临床分析165例

Endoscopic ultrasonography for inflammatory distal biliary stricture: Analysis of 165 cases

目的:探讨超声内镜(endoscopic ultrasonography,EUS)在胆道远端炎性狭窄中的治疗价值.方法:回顾性分析我中心2010-03/2013-03EUS在165例胆道远端炎性狭窄患者中的治疗效果.结果:165例患者行EUS及十二指肠镜检查及治疗共256次,分别行鼻胆管引流和/或胆道塑料支架置入术,治疗后患者临床症状均见缓解,复查肝功能明显改善,胆道压力较术前均见减轻.内镜下逆行胰胆管造影(endoscopic retrograde cholangio pancreatography,ERCP)操作成功率98.8%,术后高淀粉酶血症3例,轻度胆管炎3例,急性胰腺炎2例,并发症发生率4.84%(8/165),随访1-37 mo(平均17.8 mo±5.3mo),狭窄无复发,121例患者拔除支架,27例患者仍需定期更换支架.结论:EUS治疗胆道远段炎性狭窄安全、微创、有效.

AIM： To explore the value of endoscopic ultrasonography（EUS）in the treatment of inflammatory distal biliary stricture.METHODS： The clinical data for 165 patients with inflammatory distal biliary stricture who underwent EUS from March 2010 to March 2013were retrospectively analyzed.RESULTS： A total of 256 EUS treatments were performed in 165 patients.Endoscopic retrograde cholangiopancreatography（ERCP）and EUS were selected based on the clinical condition.Endoscopic nasobiliary drainage and/or endoscopic retrograde biliary drainage were separately used.Clinical symptoms were relieved and hepatic function was improved in all patients.Bile duct pressure was reduced.The success rate of ERCP was 98.8%.The rate of complications was 4.84%（8/165）.Three patients developed post-ERCP hyperamylasemia,3 patients developed mild cholangeitis,and 2patients developed acute pancreatitis.During a follow-up period of 1-37 mo（average,17.8 mo± 5.3 mo）,no stricture recurrence was found.Stents were removed in 121 cases,but stent replacement was required in another 29 cases.CONCLUSION： Endoscopic ultrasonography is a safe,effective and mini-invasive method for inflammatory distal biliary stricture.