内镜技术在肝外胆汁淤积病人中的诊治体会

APPLICATION OF ENDOSCOPE TECHNIQUE IN THE EXTRALIVER CHOLESTASIS

目的 :探讨内镜技术在肝外胆汁淤积病人中的诊断价值及治疗作用。方法 :对 5 8例肝外胆汁淤积病人进行前瞻性研究 ,在ERCP操作过程中 ,退镜之前做出诊断 ,进行适当的内镜下治疗。结果 :5 8例肝外胆汁淤积病人经ERCP检查 ,5 7例得到了明确诊断 ,占 98.3%。经内镜下EST或EPBD网篮取石治愈总胆管结石 38例 (38/ 4 1) ,其中 14例并胆囊结石患者中 9例内镜取石成功后放置ENBD ,再行腹腔镜胆囊切除 (LC) ;8例总胆管下端狭窄经内镜下EST术后 ,症状明显减轻 ,近期疗效良好 ;5例无法行根除手术的肿瘤患者 ,经内镜下放置内支架引流 ,1例成活 9个月 ,4例成活至今 ,平均约 5 .5个月。结论 :ERCP对肝外胆汁淤积病人有较高的诊断价值 ,特别是对肝外胆汁淤积的鉴别诊断可提供有价值的决定性诊断。内镜下治疗肝外胆管的结石 ,手术创伤小 ,治愈率高 ,患者易接受 ,同时可配合LC术 ,拓展微创外科领域 ,有条件的医院应首选内镜下排石 ;对总胆管下端狭窄EST术近期疗效满意 ;对晚期无手术根治的肿瘤患者 ,微创内镜的介入治疗可有效控制梗阻性黄疸 ,不失为一种安全有效的治疗手段。

Objective:To detect endoscope technique's dynamic value and therapeutical effect in the patien of extraliver cholestasis.Method: Fifty-eight patiens of extraliver cholestasis were prospective investigation. In the endoscopic retrograde cholangiopancreatography (ERCP) operation, we diagnosis and treat before retroendoscope.Result:Fifty-eight patiens of extraliver cholestasis through the ERCP examination, it is 98.3% (57/58) that 57 cases were final diagnosised. Thirty-eight cases of choledocholith (38/41) were cured through endoscopic sphincterotomy (EST) or endoscopic papillary ballon sphincteroplastry dilatation (EPBD) by mesh basket, 14 of 38 cases unite cholecystolithiasis ,9 cases ( 9/14 ) were endoscopic nasobiliary drainage (ENBD) after cure and soon treated by laparoscopic cholecystectomy ( LC ). Eight cases of stricture of common bile duct were cured through EST, symptom phanerorelieve and effect is well in the near future. Five cases of tumor have no choice for radical operation, they were endoscopic metal biliary endoprothesis, 1 case live for 9 months, 4 cases are on life, average 5.5 months.Conclusion:ERCP have high dynamic value in the patien of extraliver cholestasis,particular to give us final diagnosis in the differential diagnosis of extraliver cholestasis.To treat extraliver cholelithiasis through endoscope have micro-wound, high cure rate,be accepted easily and expand micro-wound Surgery with LC .This is the first choice in the conditioned hospital .EST cure stricture of common bile duct have well effect in the near future ;Interventional therapy through micro-wound endoscope can reduce obstructive jaundice. It is a safety and effect treat method really.