精准经内镜逆行胰胆管引流术在肝门部胆管癌术前减黄中的应用

Application of accurate endoscopic retrograde cholangiopancreatography drainage to preoperative jaundice reduction for hilar cholangiocarcinoma

目的探讨基于IQQA■-Liver肝脏CT影像解读分析系统精准引导下的经内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography, ERCP)引流术在肝门部胆管癌术前减黄中的应用。方法收集2017年5月-2018年12月在南京大学医学院附属鼓楼医院肝胆外科拟行外科手术治疗的12例肝门部胆管癌患者的临床资料。患者均接受ERCP减黄手术治疗,分析患者接受减黄手术成功率、术后引流量及术后并发症等。结果 12例患者均成功接受ERCP减黄手术,患者术后每日中位鼻胆管引流量675 mL(400~1 500 mL),仅有1例患者发生术后胆管炎,另有1例患者发生术后轻症胰腺炎。接受减黄手术前患者血清总胆红素为(173.3±62.8)μmol/L,外科手术前血清总胆红素水平降至(35.6±13.9)μmol/L。结论精准ERCP引流术能够有效降低肝门部胆管癌患者血清胆红素水平并减少术后胆管炎发生率,为后续外科手术创造有利条件。

Objective To investigate the application of accurate endoscopic retrograde cholangiopancreatography(ERCP)drainage guided by IQQA■⁃Liver CT(an image interpretation and analysis system)to preoperative jaundice reduction for hilar cholangiocarcinoma.Methods Data of 12 patients with hilar cholangiocarcinoma who planned to receive surgical treatment in the hepatobiliary surgery department of Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School from May 2017 to December 2018 were reviewed.All patients were treated with ERCP drainage before surgery.The procedure success rate,postoperative drainage volume and postoperative complications of the patients were analyzed.Results ERCP was successful in all patients,and the median daily volume of endoscopic nasobiliary drainage was 675 mL(400-1500 mL).Only 1 patient developed postoperative cholangitis,and another patient developed postoperative mild pancreatitis.The mean serum total bilirubin was 173.3±62.8μmol/L in the patients before ERCP,which decreased to 35.6±13.9μmol/L before surgery.Conclusion Accurate ERCP drainage can effectively reduce the serum bilirubin level in patients with hilar cholangiocarcinoma and reduce the incidence of cholangitis after the procedure,creating favorable conditions for subsequent surgical operations.