治疗性经内镜逆行胰胆管造影在胆胰疾病治疗中的应用

Role of therapeutic endoscopic retrograde cholangiopancreatography in treatment of pancreaticobiliary diseases

目的分析治疗性经内镜逆行胰胆管造影（ERCP）对胆胰疾病患者肝功能和治疗效果的影响。方法筛选2005年1月-2015年7月北京市垂杨柳医院应用电子十二指肠镜行ERCP治疗的397例胆胰疾病患者。根据不同病种分为8组：良性梗阻组（109例）、恶性梗阻组（47例）、胰腺炎组（27例）、异物梗阻组（127例）、单纯性胆管炎组（19例）、胆瘘组（15例）、十二指肠乳头憩室组（29例）、肝移植术后组（24例）。实施ERCP前1天和实施ERCP 4周后检测受试者的肝功能：ALT、AST、ALP、GGT和TBil。ERCP治疗完成后1个月对疗效进行全面评估。计量资料同组治疗前后比较采用配对t检验,多组间比较采用方差分析;计数资料组间比较采用χ^2检验。结果各组受试者实施ERCP后,其ALT、AST、ALP、GGT以及TBil均有显著改善,即ERCP可以明显改善受试者肝功能（P值均〈0.05）。疗效评估发现,ERCP治疗后,各组的症状均有明显缓解,单纯性胆管炎组全部治愈,而肝移植术后组和恶性梗阻组只能达到好转的效果。结论治疗性ERCP可显著改善患者的肝功能;但对肝移植术后患者和胆胰肿瘤患者,需要在进行ERCP治疗的同时实施腹腔镜手术联合治疗。

Objective To investigate the effect of therapeutic endoscopic retrograde cholangiopancreatography（ ERCP） on liver function and treatment outcome in patients with pancreaticobiliary diseases. Methods A total of 397 patients with pancreaticobiliary diseases who underwent ERCP with an electronic duodenoscope in Beijing Chuiyangliu Hospital from January 2005 to July 2015,were enrolled. According to the type of disease,they were divided into benign obstruction group（ 109 patients）,malignant obstruction group（ 47 patients）,pancreatitis group（ 27 patients）,foreign body obstruction group（ 127 patients）,simple cholangitis group（ 19 patients）,biliary fistula group（ 15patients）,juxta- ampullary duodenal diverticula group（ 29 patients）,and liver transplantation group（ 24 patients）. Liver function parameters including alanine aminotransferase（ ALT）,aspartate aminotransferase（ AST）,alkaline phosphatase（ ALP）,γ- glutamyl transpeptidase（ GGT）,and total bilirubin（ TBil） were measured at 1 day before ERCP and at 4 weeks after ERCP. The therapeutic effect was evaluated at 1 month after ERCP. The paired t- test was used for comparison of continuous data before and after treatment within one group,an analysis of variance was used for comparison between multiple groups,and the chi- square test was used for comparison of categorical data between groups. Results After ERCP,all the patients showed significant improvements in ALT,AST,ALP,GGT,and TBil,suggesting that ERCP significantly improved the subjects＇ liver function（ all P〈0. 05）. The evaluation of therapeutic effect showed that after ERCP,all the groups showed significant remission of symptoms; all the patients in the simple cholangitis group were cured,while those in the liver transplantation group and malignant obstruction group only achieved certain improvements. Conclusion Therapeutic ERCP can significantly improve the patients＇ liver function. However,as for patients with liver transplantation and pancreaticobiliary tumors,laparoscopic surgery should be performed in combination with ERCP.