ERCP治疗胆总管结石临床疗效及其相关并发症分析

ERCP analysis of clinical efficacy and complications of the treatment of common bile duct stones

目的探讨内镜下逆行胰胆管造影（ERCP）治疗胆总管结石患者的临床疗效及其相关并发症。方法严格筛选纳入从2012年1月—2015年1月在我院行ERCP治疗的胆总管结石患者,归纳评估ERCP手术对胆总管结石治疗的有效性及安全性。结果 359例胆总管结石患者,其中行ERCP治疗共347例,其中9例因一般情况差无法耐受手术或无法配合而未予以实施ERCP治疗,其中3例因术中穿孔转为开放手术治疗。1次性取净结石者311例（89.6%）,结石2次以上（含2次）取净者27例（7.8%）,放置胆道支架者9例（2.6%）。ERCP术后总胆红素（61.7±103.8）μmol/L;直接胆红素（34.7±59.6）μmol/L;谷丙转氨酶（62.8±74.2）U/L;谷草转氨酶（48.3±61）U/L。术后2 h血淀粉酶（115±162）U/L,无统计学差异（P〉0.05）,24 h血淀粉酶（124.7±215.8）U/L,与术前相比差异有统计学意义（P〈0.05）。术后寒战、发热、腹痛、黄疸等症状均有不同程度的减轻;肝功能术后明显好转（P〈0.05）;术后平均住院天数4~6 d;出现并发症患者16例,其中急性胰腺炎占6例,急性胆管炎占5例,出血占3例,穿孔占2例,经对症支持治疗后均治愈出院。结论 ERCP治疗胆总管结石安全、有效,临床疗效显著,是胆胰疾病重要的诊治手段。

Objective To investigate the clinical efficacy and complications of endoscopic retrograde cholangiopancreatography（ ERCP） in the treatment of common bile duct stones. Methods Cases received ERCP therapy from January 2012 to January 2015 were studied retrospectively,and evaluated the safety and efficacy of therapeutic ERCP in patients with common bile duct calculi. Results 359 Cases of patients with common bile duct stones treated successfully with 347 cases,among them 9 cases unable to implementation of ERCP because of bad surgery tolerance,3 cases of intraoperative perforation to have surgical operation treatment. The stones were removed completely one time in 311 cases（ 89. 6%）. More than two times removing net calculi in 27 cases（ 7. 8%）. 9 cases were placed biliary stent（ 2. 6%）. Postoperative total bilirubin ERCP： 61. 7 ±103. 8 μmol / l; Postoperative bilirubin direct： 34. 7 ± 59. 6 μmol / l; Postoperative ALT： 62. 8 ± 74. 2 U / L; Postoperative AST：48. 3 ± 61 U / L; Postoperative 2 h blood amylase was 115 ± 162 U / L. It showed no significant difference（ P 〉 0. 05）. 24 h blood amylase was 124. 7 ± 215. 8 U / L,there was significant difference compared with before operation（ P 〈 0. 05）. Postoperative chills,fever,pain,jaundice have different degrees of ease. Postoperative liver function was improved significantly（ P 〈 0. 05）.The postoperative average length of stay in common bile duct stones was 4 ~ 6 days. Complications occurred in 16 cases,including 6 cases of acute pancreatitis,5 cases of acute cholangitis,3 cases of bleeding,perforation in 2 cases. After treatment they were cured and discharged. Conclusion ERCP is safe,effective in treatment of common bile duct stones. It is an important means in treatment in bile duct diseases.