经内镜胆道引流治疗胆道梗阻

Endoscopic biliary drainage for biliary obstruction

目的 进一步提高经内镜胆道引流术的成功率。方法 总结 1998年 1月至2001年9月对320例胆道梗阻患者行十二指肠镜下各种胆道引流术的经验,其中鼻胆管引流术（ENBD）242例,胆道内置管引流术（ERBD）43例,胆道金属支架术（EMBE）35例。结果305例得到成功引流,胆道梗阻症状缓解;失败15例。其中ENBD失败10例,经调整鼻胆管位置或重新置管获得成功;ERBD失败3例,2例选用合适长度的支架后引流成功,1例经努力仍未成功改用经皮肝穿刺胆道引流;EM-BE失败2例,其中1例金属支架未超出肿瘤狭窄段,经原金属支架再套入另一金属支架而成功,另1例支架放置1月又出现胆道阻塞,经原金属支架通道再放入塑料支架而恢复通畅引流。结论 经内镜引流治疗胆道梗阻疗效确切,及早分析内镜引流失败原因并采取相应的对策,绝大多数引流失败是可以避免或补救的。

Objective To improve the successful rate of endoscopic biliary drainage. Methods The experience of biliary drainage with duodenoscope for biliary obstruction from January 1998 to September 2001 was reviewed retrospectively. Endoscopic naso -biliary drainage (ENBD) , endoscopic retrograde biliary drainage (ERBD) and endoscopic metal biliary endoprothesis (EMBE) were performed in 242 cases, 43 cases and 35 cases respectively. Results Of 320 cases with biliary obstruction, 305 received successful drainage under endoscopy and 15 cases failed. Ten cases with ENBD failed but got successful drainage after modulating the site of naso-biliary tube or reinserting another tube. For 3 cases failed with ERBD, we chose plastic stents with appropriate length for 2 cases to achieve fluent drainage and percutaneous transhepatic biliary drainage (PTBD) was managed for another case after endoscopic management failed. For 2 cases with EMBE failed, one stent couldn' t exceed the tumor stricture site and one was obstructed by tumor implantion at one month after EMBE. Either a metal stent or a plastic stent was replaced through previous prothesis in these two failed cases. Conclusions The effect of endoscopic biliary drainage for biliary obstruction is definite. Mostly the drainage failure can be avoided as early as possible by analyzing the causes and taking some corresponding measures to correct it.