ERCP在医源性胆管损伤中的诊治价值

The value of ERCP in the diagnosis and treatment of postoperative benign biliary stricture

目的 :探讨ERCP对医源性胆管损伤的诊断价值。方法 :通过对 2 2例医源性胆管损伤行ERCP检查 ,分析判断胆管损伤部位、程度及类型 ,根据需要进行内镜下扩张引流或取石治疗。结果 :狭窄部位 :位于肝总管近端 3例 (占 13 .6 % ) ,远端 2例 (占 9.1% ) ,总胆管中上段 17例 (占 77.3 % )。其中环形狭窄 4例 (占18.1% ) ,线形狭窄 3例 (占 13.6 % ) ,闭塞型狭窄 5例 (占 2 2 .7% ) ,胆管中断 10例 (占 45 .5 % )。内镜下治疗13例次 ,其中胆管探条扩张后放置 7 8.5Fr内置架引流 (ERBD) 8例 (占 36 .4% ) ) (其中 2例先行ENBD 1周后再行ERBD) ,乳头切开 (EST)取石 3例 (占 13.6 % )。结论 :ERCP对医源性胆管损伤具有重要的诊治价值。

Objective:To study the clinical value of endoscopic retrograde cholangiopancreatography(ERCP) in the diagnosis and treatment of postoperative benign biliary stricture.Methods:From January 1996 to January 2000,twenty two patients with benign biliary stricture caused by cholecystectomy were examined with ERCP. Among them,14 cases were male and 8 cases were female,whose age range was 19～72 years. The time of syndrom occurence after operation was between 2 days and 2 years,of them 16 cases(72.7%) were within one month.Results:The stricture was located in the middle and supper part of common bile duct in 17 cases(77.3%)?in the distal part of extrahepatic duct in 3(13.6%) and in proximal part of extrahepatic duct in 2(9.1%). The feature of ERCP included circumferentiel stricture in 4 cases(18.1%)?thread stricture in 3 cases(13.6%)?closed stricture in 5 cases(22.7%) and divorced stricture in 10 cases(45.1%). Thirteen times of endoscopical treatment were done,including ERBD in 8(ENBD was perfomed in 2 a week before) and removing common bile duct stone in 3 after EST. Conclusion:ERCP has an important value in the diagnosis and treatment of benign postoperative biliary stricture.