内镜逆行胰胆管造影治疗缺血型胆道损伤临床价值

Clinical value of ERCP in the treatment of ischemic-type biliary lesion

目的探讨内镜逆行胰胆管造影(ERCP)在缺血型胆道损伤治疗中的作用及临床价值。方法回顾性分析自2008年1月至2017年8月解放军309医院采用ERCP治疗的50例缺血型胆道损伤的患者临床资料,根据缺血型胆道损伤原因分为肝移植组(n=20)、腹腔镜胆囊切除术组(n=18)及肝动脉栓塞化疗术组(n=12)。观察本组患者总治愈率、ERCP治疗次数及并发症发生情况,测定并比较各组患者总胆红素、谷丙转氨酶在术后1周较术前的下降程度。结果所有50例患者均成功完成ERCP治疗,共行ERCP治疗79次,行鼻胆管引流35人次,放置支架44人次。本组患者的总治愈率为70. 0%(35/50),有效率90. 0%(45/50),并发症发生率为12. 0%(6/50)。其中,ERCP治疗1次治愈患者25例,2次治愈患者6例,3次治愈患者4例。3组患者总胆红素、谷丙转氨酶在术后1周较术前下降程度比较,差异均无统计学意义(P> 0. 05)。结论 ERCP治疗缺血型胆道损伤安全、微创,治疗效果较好。

Objective To investigate the clinical value of endoscopic retrograde cholangiopancreatography（ERCP）in the treatment of ischemic-type biliary lesion.Methods A retrospective study was performed on 50 cases of patients with ischemic-type biliary lesion who were admitted and underwent ERCP from January 2008 to August 2017.According to the causes of ischemic-type biliary lesion,patients were divided into the liver transplantation group（ n =20）,laparoscopic cholecystectomy group（ n =18）and hepatic artery embolization chemotherapy group（ n =12）.The total cure rate,ERCP treatment frequency and complications were observed.The total bilirubin and alanine aminotransferase levels in each group were compared with those before surgery after 1 week of surgery.Results All the fifty patients underwent ERCP successfully with totally 79 times.Nasobiliary drainage was performed 35 person-times,stent placement 44 person-times.The total cured rate of all the patients was 70%（35/50）and the effective rate was 90%（45/50）.The incidence of complications was 12% （6/50）.Among them,25 patients were cured by ERCP in 1 time,6 patients were cured twice,and 4 patients were cured in 3 times.The total bilirubin and alanine aminotransferase in the three groups were compared with those before surgery at 1 week after operation,and the difference was not statistically significant（ P 〉0.05）.Conclusion ERCP is safe,minimally invasive for the treatment of ischemic-type biliary lesion,and the treatment effect is better.