经十二指肠镜治疗胆道疾病387例

Experience in treating 387 cases of bile duct diseases under duodenoscope

目的 探讨如何提高十二指肠镜治疗胆道疾病的疗效及减少并发症的发生。 方法 对 1995年 2月～ 2 0 0 3年2月经内镜行Oddi括约肌切开术 (endoscopicsphincterotomy,EST) 2 92例、鼻胆管引流术 (endoscopicnasobiliarydrainage ,ENBD) 10 4例 (其中 9例EST后引流 )的临床资料作回顾性分析。 结果 EST成功 2 6 9例 ,成功率 92 1% (2 6 9/2 92 )。 2 72例胆总管结石中 2 35例取尽结石 (86 4 % ) ;15例肝内胆管结石 ,4例取尽 ;5例胆管异物 ,3例当即取尽。EST治疗发生并发症 16例 ,发生率5 5 % (16 /2 92 ) ,包括急性胰腺炎 7例和乳头切开处出血 5例 ,继发重症胆管炎 2例 ,十二指肠穿孔 1例 ,碎石时钢索末端断裂 1例。ENBD疗效满意 92例。所有病例均未发生与操作相关的死亡。 结论 严格EST适应证选择、提高EST技术是提高疗效、减少并发症的关键。

Objective To explore how to improve the curative effects and reduce the complications of duodenoscopy in the treatment of bile duct diseases. Methods Clinical data of 292 cases of endoscopic sphincterotomy (EST) and 104 cases of endoscopic nose biliary drainage (ENBD, including 9 post-EST cases) from February 1995 to February 2003 were retrospectively reviewed. Results The success rate of EST was 92.1% (269/292). Among 272 cases of common bile duct calculus, stones were completely taken out in 235 cases (86.4%). Among 15 cases of intrahepatic duct calculus, stones were completely removed in 4 cases. Biliary duct foreign bodies were removed at once in 3 out of 5 cases. EST related complications were found in 16 cases (7 cases of acute pancreatitis, 5 cases of bleeding at the site of incision, 2 cases of severe cholangitis, 1 case of duodenal perforation and 1 case of instrumental break-off), with an incidence rate of 5.5% (16/292). Satisfactory outcomes were achieved in 92 cases receiving ENBD. No death occurred in the study. Conclusions Proper selection of patients and skillful performance of EST is the key to improve its curative effects and reduce its complications.