胆源性肝脏疾病消化内镜的诊断与治疗

Gastrointestinal endoscopy in the diagnosis and treatment of biliary liver disease

胆源性肝脏疾病指肝内外胆管系统病变或胆管上皮细胞损伤,导致肝功能异常和肝脏炎症及纤维化,主要表现为慢性胆汁淤积性肝病。常见原因包括原发性胆汁性胆管炎、原发性硬化性胆管炎、进行性家族性肝内胆汁淤积症、肝移植术后胆管并发症、药物或严重感染所致的胆管消失综合征等。瘙痒和黄疸是最突出症状,影响患者的生活质量。逆行十二指肠镜胰胆管造影术、胆胰子镜直视系统(SpyGlass)等内镜检查,可显著提高原发性硬化性胆管炎、免疫球蛋白G4相关胆管炎与胆管癌的早期鉴别诊断能力,实现精准细胞学及活组织检查。经内镜鼻胆管引流术、球囊扩张术及胆管内支架置入术可显著改善瘙痒症状、肝脏生物化学指标和预后。因此,消化内镜在胆源性肝脏疾病诊断与治疗中显示了重要价值和应用前景。

Biliary liver disease refers to intrahepatic and extrahepatic bile duct system lesions or bile duct epithelial cells damage,resulting in abnormal liver function,inflammation and fibrosis,which mainly manifests as chronic cholestatic liver disease.The common causes include primary biliary cholangitis,primary sclerosing cholangitis,progressive familial intrahepatic cholangitis,bile duct complications after liver transplantation,and vanishing bile duct syndrome caused by drugs or serious infections,and the most prominent symptoms affecting the patients quality life is pruritus and jaundice.Endoscopic retrograde duodenoscopic cholangiopancreatography and cholangiopancreatoscopy(SpyGlass)and other endoscopic examinations can significantly improve the accuracy of early differential diagnosis,cytology and biopsy of primary sclerosing cholangitis,immunoglobulin G4-related cholangitis and cholangiocarcinoma.Endoscopic nasobiliary drainage,balloon dilatation and intrabiliary stent implantation can significantly improve pruritus symptoms,liver biochemical indicators and prognosis.Therefore,gastrointestinal endoscopy has important value and application prospects in the diagnosis and treatment of biliary liver diseases.