治疗性ERCP319例分析

The Analysis of 319 Cases of Therapeutic ERCP

目的:探讨经内镜乳头括约肌切开术(EST)治疗胰胆管疾病的疗效和并发症的防治措施。方法:回顾ERCP检查453例,其中319例进行了EST治疗,探讨了在各种情况下如何进行EST治疗和提高其成功率及并发症的治疗和预防效果。结果:319例中胆总管结石214例(67.1％)经EST取石成功。胆总管泥沙样结石25例(7.8％),经EST切开作ERBD引流治疗。胆总管狭窄及扩张46例(14.4％),经EST切开作网石篮或气囊扩张治疗。化脓性胆管炎6例(1.9％),急性梗阻性胰腺炎4例(1.3％),经EST切开引流治疗成功。胆总管癌9例(2.8％),胰头癌8例(2.5％),壶腹部癌7例(2.2％),经EST切开后作ERBD引流治疗。结论:EST术在治疗胆总管结石中适应症范围广,尤其适用于老年患者和胆囊切除术后胆总管残石患者。化脓性胰胆管炎和梗阻性胰腺炎的治疗,方法简单可靠,可降低死亡率,具有重要的临床意义。

Objective:To evaluate the efficacy of EST in treating pancreatic and choledochal diseases and their complications. Methods:453 cases of ERCP, of which 319 underwent EST, were retrospectively analysed. The way of carrying out EST, getting more efficacies, and preventing and treating its complications under any circumstance were studied. Results: By means of EST the choledoch stones were removed in 214 (67. 1%) cases, EST,25(7. 8%) cases were found to have sand stones, and treated with ERBD drainage ,in 46(l4.4%) cases the CBD stricture or dilation were found and, papilary balloon dilation was producted; 6 cases. (1.9%) had festering chokngitis and 4( 1.3% ) had acute infarctional pancreatitis, the drainage achieved success in them, all of the patients were cured; 9(2.8%) cases had carcinoma of CBD , 8(2.5%) had carcinoma of the head of pancreas, 7(2.2%) had carcinoma of ampulla, and ERBD drainages were conducted successfully. Conclusion: EST is better in treating choledoch stones than other methods, especially for elderly patients and patients who suffer from residual stone in choledoch after choleeystectomy. It can lower death toll in festering cholangitis and choledoch stone, compared with surgical treatment. So EST is of importance in clinic.