内镜下逆行胰胆管造影术在胆胰疾病中的应用

Application of endoscopic retrograde cholangiopancreatography in biliary and pancreatic diseases

目的:探讨治疗性内镜下逆行胰胆管造影术(ERCP)在胆胰疾病的手术方式、适应证及时机,以指导治疗方式的合理选择。方法:对2008年7月至2013年11月,经ERCP诊治的1421例患者病例资料进行回顾分析。结果:1421例患者中,共进行ERCP 1643例,其中2次ERCP 176例、3次及以上ERCP 43例,诊断性ERCP 21例,绝大部分行治疗性ERCP。治疗病例中胆管结石759例;恶性肿瘤248例;急性梗阻性化脓性胆管炎184例;急性胆源性胰腺炎82例;慢性胰腺炎18例;乳头良性狭窄9例;医源性胆道损伤40例;胆漏33例;胆道蛔虫13例;梗阻性黄疸35例。首次ERCP胆管插管失败率为6.82%;并发症发生率4.75%,无死亡病例。结论:合理选择ERCP手术方式,严格掌握适应证及时机,可有效提高胰腺疾病的治疗效果。

Objective:To explore the operation mode,indication and timing of therapeutic endoscopic retrograde cholangiopancreatography(ERCP)in cholangiopancreatic diseases,so as to guide the reasonable choice of treatment mode.Methods:The clinical data of 1421 patients undergoing ERCP from July 2008 to November 2013 were analyzed retrospectively.Results:In 1421 patients,ERCP was performed 1643 times,including 176 ERCP twice,43 ERCP three times or more,21 diagnostic ERCP times,and most of them were therapeutic ERCP.Among the treatment cases,759 cases of cholelithiasis,248 cases of malignant tumors,184 cases of acute obstructive suppurative cholangitis,82 cases of acute biliary pancreatitis,18 cases of chronic pancreatitis,9 cases of benign papillary stenosis,40 cases of iatrogenic bile duct injury,33 cases of bile leakage,13 cases of biliary ascaris and 35 cases of obstructive jaundice.The failure rate of the first ERCP was 6.82%,and the complication rate was 4.75%,and there was no death.Conclusion:Reasonable selection of ERCP operation mode and strict control of indications and timing can effectively improve the therapeutic effect of pancreatic diseases.