ERCP在胆管损伤中的应用价值

The diagnostic and therapeutic value of ERCP in biliary tract injury

目的探讨内镜下逆行胰胆管造影术(ERCP)在胆管损伤中的诊断及治疗价值。方法回顾分析我科46例胆管损伤患者行ERCP治疗的临床资料,46例患者大多由胆管手术引起,少部分患者是由外伤和胰腺炎引起,临床上最常见的原因是由腹腔镜胆囊切除术、胆管重建术引起。胆管损伤可分为胆漏型和狭窄性,通过ERCP行鼻胆管引流或胆管内支架植入术治疗。结果46例患者中2例因狭窄部位位于肝门部,效果欠佳而行胆肠吻合术,1例胆管狭窄患者术后复发,43例患者均取得良好效果,随访6个月未发现胆漏和再次胆管狭窄。结论ERCP以其微创性、可反复操作、疗效可靠,已成为胆管损伤优先选择的治疗方法。同时ERCP也可为内镜治疗疗效欠佳的患者,明确损伤部位及程度,为下一步外科手术治疗提供帮助。

Objective cholangiopancreatography(ERCP) in biliary tract injury.Methods The clinical data of 46 patients with biliary tract injury who were treated by ERCP in our hospital were retrospectively analyzed.Most of the patients were caused by biliary tract surgery,and a small part of patients were caused by trauma and pancreatitis,and the most common clinical reasons were caused by laparoscopic cholecystectomy and biliary tract reconstruction.Biliary tract injuries could be classified as bile leakage type and stenosis,which could be treated by nasobiliary drainage or biliary stent implantation through ERCP.Results Among the46 patients,2 patients received choledochojejunostomy due to the stenosis position at porta hepatis,and 1 patient with stenosis of bile duct had relapse after operation,and 43 patients had good results.Moreover no bile leakage cases or restenosis cases were found after 6-month follow up.Conclusion The endoscopic retrograde cholangiopancreatography has become the preferred treatment way for biliary tract injury,which has the advantages of minimally invasion,repeatable operation and reliable efficacy.At the same time,ERCP can also be used to identify the site and degree of injury in patients with poor efficacy of endoscopic therapy,so as to provide help for further surgical treatment.