内镜逆行胰胆管造影胆道引流在肝门部胆管癌外科围术期中的应用

Application of endoscopic retrograde cholangiopancreatography drainage in surgical treatment of hilar cholangiocarcinomas

目的：探讨内镜逆行胰胆管造影（ ERCP ）胆道引流在肝门部胆管癌外科手术前减轻黄疸中的可行性、疗效和安全性。方法回顾性分析西安交通大学第一附属医院肝胆外科2013年1月至2013年12月19例术前诊断肝门部胆管癌患者实施ERCP胆道引流的引流方式、有效率、并发症发生率及手术情况。结果19例患者均一次性完成ERCP胆道引流，其中，鼻胆管引流（ ENBD）单侧（左／右）胆管4例，ENBD ＋塑料支架引流单侧胆管9例，ENBD＋塑料支架引流左右肝管6例，引流有效率为89．5％（17／19），术后1周肝功能及凝血指标均较术前显著下降[ ALT：（208．4±47．7） U／L 与（90．3±31．57） U／L，TBIL：（421．7±85．9）μmol／L与（150．1±49．7）μmol／L，DBIL：（294．6±30．6）μmol／L与（95．4±23．2）μmol／L，ALP：（853．1±133．7） U／L 与（600．0±116．4） U／L，PT：（17．7±1．8） s 与（13．8±1．0） s；P值分别为0．000、0．001、0．000、0．001、0．004]。 ERCP术后并发症有6例，其中高淀粉酶血症2例，胰腺炎1例，胆管炎3例。7例肝门部胆管癌患者接受联合尾状叶切除的左／右半肝切除高位胆管癌根治手术，术后无胆管炎发生。结论 ERCP胆道引流是肝门部胆管癌围术期保证手术安全和疗效的重要手段。

Objective To explore the feasibility,efficacy and safety of endoscopic retrograde cholangio-pancreatography （ ERCP ） drainage during peroperation of hilar cholangiocarcinoma for alleviate jaun-dice. Methods Nineteen cases patients with hilar cholangiocarcinoma who were treated with ERCP in the First Affiliated Hospital of Xi＇an Jiao Tong University from January 2013 to December 2013,the drainage way,efficient rate,complication rate,and surgical situation were retrospective analyzed. Results Bilateral endoscopic drain-age was one-time achieved in all 19 patients. Among them,Eendoscopic nasobiliary drainage（ ENBD） for unilat-eral bilateral drainage was 4 cases,ENBD and plastic stent for unilateral（ left or right） drainage was 9 cases,EN-BD and plastic stent for bilateral drainage was 6 cases. The drainage efficiency rate was 89. 5% （ 17/19） . Serum alanine aminotransferase（ALT）,total bilirubin（TBIL）,direct bilirubin（DBIL）,alkaline phosphatase（ALP） and Prothrombin time （PT） were significantly decreased after 7days post-ERCP（（208. 4±47. 7） U/L vs. （90. 3 ±31. 57） U/L,（421. 7±85. 9） μmol/L vs. （150. 1±49. 7） μmol/L,（294. 6±30. 6） μmol/L vs. （95. 4±23. 2）μmol/L,（853. 1±133. 7） U/L vs. （600. 0±116. 4） U/L,（17. 7±1. 8） s vs. （13. 8±1. 0） s;P=0. 000,0. 001, 0. 000,0. 001,0. 004） . There were 6 cases occurred ERCP postoperative complications,including 2 cases of hy-peramylasemia, 1 case of pancreatitis, 3 cases of cholangitis. Seven cases of hilar cholangiocarcinoma patients were received hilar radical surgery by combination caudate lobectomy of the left or right hepatectomy,no postop-erative cholangitis was occurred. Conclusion ERCP biliary drainage is an important means to ensure the perio-perative safety and efficacy of hilar cholangiocarcinoma.