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医源性胆道损伤的内镜治疗

Endoscopic Therapy for Iatrogenic Bile Duct Injuries

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【作者】 苏秉忠陈平黄应龙于金华马丽丽

【Author】 SU Bing-zhong CHEN Ping HUANG Ying-long YU Jin-hua MA Li-li Department of Gastroenterology, the First Affiliated Hospital of Inner Mongolia Medical College, Huhehaote,010050, China

【机构】 内蒙古医学院第一附属医院消化内科内蒙古医学院第一附属医院消化内科 呼和浩特010050呼和浩特

【摘要】 目的探讨十二指肠镜在胆道手术后胆管损伤的诊断与治疗价值。方法回顾性分析我院3年来ERCP对胆道损伤的诊断价值及ENBD、ERBD对医源性胆道狭窄和胆漏的治疗效果。结果在424例ERCP检查和治疗的病例中有19例胆管良性狭窄和11例胆漏患者。19例胆管良性狭窄患者为胆囊切除术后,其中10例为腹腔镜下胆囊切除术(LC)后。11例放置ERBD,8例放置ENBD治疗,放置时间为2~3个月,拔管后随访6~36个月不等。其中5例拔管8个月后又出现黄疸,再次置管,3例反复置管10~24个月至随访结束,8例拔管后胆管通畅,最长2例达到36个月。3例高位狭窄患者,由于完全梗阻,导丝无法通过,内镜下放置支架失败而采取外科治疗;11例胆漏患者3例为开腹胆囊切除术损伤所致,8例为LC后胆漏。4例经内镜放置ERBD,7例放置ENBD。拔管后胆道通畅,漏口闭合。随访无再发狭窄和胆漏者。结论内镜是诊断与治疗胆道损伤的一种有效方法,尤其对胆漏可以达到根治的目的。

【Abstract】 Objective: To Evaluate the clinical value of endoscopic diagnosis and therapy of bile duct injuries secondary biliary tract surgery. Methods: To Analyse retrospectively for articals on the using of endoscopy in diagnosis of bile duct injuriers at our hospital in three years,and observe therapeutic effect of endoscopic retrograde biliary drainage (ERBD) and endoscopic nasobiliary drainage (ENBD) for the biliary leakage and bile duct stricture. Results: 19 cases of bile duct stricture and eleven cases of biliary leakage caused by surgery were diagnosed by Endoscopic cholangiopancreatograpy (ERCP). All cases of the bile duct stricture occurred after cholecystectomy, and in which 10 cases suffered from laparoscopic cholecystectomy (LC).11 cases and 8 cases of them were treated by ERND and ERBD, respectively. The ENBD and ERBD were implanted for two to three months and followed up for six to thirty six months after ENBD and ERBD removed. Three patients also recovered after installation ERBD for a longer time. The longest time was thirty six months. Another three bile duct stricture patients were operated because of the severe stricture and failure of endoscopic treatment. 3 patients of biliary leakage occurred after abdominal chlolecystetomy, and 8 patients occurred after LC. 4 patients implanted with ERBD for three to four weeks were recovered after it removed, while another seven patients were recovered by ENBD for six to eight weeks. There were no patients recurrence. Conclusion: Endoscopic treatment of bile duct injuries including biliary leakage and bile duct strictures was excellent and become the first choice therapy.

【关键词】 胆道损伤内镜治疗
【Key words】 Biliary leakageBile duct strictureEndoscopic therapy
  • 【文献出处】 中国消化内镜 ,Digestive Disease and Endoscopy , 编辑部邮箱 ,2007年07期
  • 【分类号】R657.4
  • 【下载频次】98
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