CAJ | 학술논문

目的探讨内镜下逆行性胰胆管造影术（ERCP）治疗肝移植术后胆道并发症的围手术期管理。方法本前瞻性研究对象为2008年12月至2012年12月在中山大学附属第三医院消化内镜中心接受ERCP治疗的102例肝移植术后胆道并发症患者。其中男90例，女12例；年龄23～65岁，中位年龄56岁。所有患者均签署知情同意书，符合医学伦理学规定。术前给予患者针对性心理疏导、严格器械消毒、应用术前药物等积极准备，术中医护人员密切配合，术后给予禁食、输液、抗感染、制酸剂、生长抑素等对症处理，妥善固定鼻胆管，密切观察病情，出院后给予健康指导。结果102例患者中成功获得ERCP治疗94例，成功率为92.2%（94/102）。94例患者治愈率77%（72/94），好转率20%（19/94），总有效率97%（91/94）。患者发生术后并发症15例，其中高淀粉酶血症8例、轻型胰腺炎4例、乳头肌切口出血3例，均经保守治疗痊愈。结论术前积极心理疏导、术中医护人员密切配合、术后严密观察并发症情况及出院后健康指导为ERCP治疗肝移植术后胆道并发症成功的重要因素。
목적탐토내경하역행성이담관조영술（ERCP）치료간이식술후담도병발증적위수술기관리。방법본전첨성연구대상위2008년12월지2012년12월재중산대학부속제삼의원소화내경중심접수ERCP치료적102례간이식술후담도병발증환자。기중남90례，녀12례；년령23～65세，중위년령56세。소유환자균첨서지정동의서，부합의학윤리학규정。술전급여환자침대성심리소도、엄격기계소독、응용술전약물등적겁준비，술중의호인원밀절배합，술후급여금식、수액、항감염、제산제、생장억소등대증처리，타선고정비담관，밀절관찰병정，출원후급여건강지도。결과102례환자중성공획득ERCP치료94례，성공솔위92.2%（94/102）。94례환자치유솔77%（72/94），호전솔20%（19/94），총유효솔97%（91/94）。환자발생술후병발증15례，기중고정분매혈증8례、경형이선염4례、유두기절구출혈3례，균경보수치료전유。결론술전적겁심리소도、술중의호인원밀절배합、술후엄밀관찰병발증정황급출원후건강지도위ERCP치료간이식술후담도병발증성공적중요인소。
Objective To investigate the perioperative management of endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of biliary complications following liver transplantation (LT). Methods A total of 102 patients with biliary complications following LT undergoing ERCP in Digestive Endoscopy Center, the Third Afifliated Hospital of Sun Yat-sen University from December 2008 to December 2012 were included in this prospective study. There were 90 males and 12 females with the age ranging from 23 to 65 years old and a median of 56 years old. The informed consents of all patients were obtained and the ethical committee approval was received. Positive preoperative preparations were given to the patients:personalized psychological counseling, strict disinfection of surgical instruments, application of preoperative drugs, et al. The operators and nursing staff cooperated closely during the operation. Symptomatic treatments such as fasting, transfusion, anti-infection, antacids, somatostatin were given to the patients after operation. The nasobiliary ducts were properly ifxed and the conditions were closely observed. Health guidance was given to the patients after hospital discharge. Results In 102 patients, 94 patients were treated by ERCP successfully with the success rate of 92.2% (94/102). The curative rate was 77%(72/94), the improvement rate was 20%(19/94) and the total effective rate was 97%(91/94). Postoperative complications were observed in 15 cases including hyperamylasemia (n=8), mild pancreatitis (n=4), bleeding of the papillary muscles incision (n=3), and all were cured by conservative treatments. Conclusions Positive preoperative psychological counseling, close collaboration of medical staff during the operation, close observation on the postoperative complications and health guidance after hospital discharge are important factors for the success of ERCP in treating biliary complications following LT.