CAJ | 학술논문

目的探讨内镜治疗胆道术后良性胆管狭窄的临床疗效.方法回顾性分析2007年1月至2011年12月兰州大学第一医院采用内镜治疗的127例胆道术后良性胆管狭窄患者的临床资料.其中Bismuth Ⅰ型60例、Ⅱ型35例、Ⅲ型21例、Ⅳ型11例.分析不同Bismuth分型良性胆管狭窄的内镜治疗效果.结果 127例患者入院后施行胆道成像+ERCP确定狭窄部位及严重程度.16例(其中BismuthⅢ型7例、Ⅳ型9例)患者因为胆管狭窄严重,首次内镜治疗时导丝及配件无法通过,放弃内镜治疗,转手术治疗.111例患者成功实施内镜治疗,成功率为87.4％ (111/127).内镜治疗Bismuth Ⅰ、Ⅱ、Ⅲ、Ⅳ型胆管狭窄的有效率分别为95％ (57/60)、86％( 30/35)、9/14和1/2.29例患者放置可回收覆膜金属胆管支架,82例放置塑料胆管支架.111例患者术后无严重并发症发生,仅6例发生轻症急性胰腺炎,经保守治疗痊愈.内镜治疗1周后患者的皮肤黏膜黄染、右上腹压痛、右上腹胀痛、发热缓解率分别为73％ (81/111)、83％( 74/89)、90％ (73/81)和89％ (68/76)；术后8周上述指标缓解率分别为88％ (98/111)、91％ (81/89)、94％(76/81)和92％ (70/76).111例内镜治疗成功的患者中97例效果良好,14例效果欠佳,转开腹手术治疗.术后6个月所有患者皮肤黏膜黄染、右上腹压痛、右上腹胀痛、发热等症状完全缓解.结论内镜治疗胆道术后良性胆管狭窄安全、有效.
목적 탐토내경치료담도술후량성담관협착적림상료효.방법 회고성분석2007년1월지2011년12월란주대학제일의원채용내경치료적127례담도술후량성담관협착환자적림상자료.기중Bismuth Ⅰ형60례、Ⅱ형35례、Ⅲ형21례、Ⅳ형11례.분석불동Bismuth분형량성담관협착적내경치료효과.결과 127례환자입원후시행담도성상+ERCP학정협착부위급엄중정도.16례(기중BismuthⅢ형7례、Ⅳ형9례)환자인위담관협착엄중,수차내경치료시도사급배건무법통과,방기내경치료,전수술치료.111례환자성공실시내경치료,성공솔위87.4％ (111/127).내경치료Bismuth Ⅰ、Ⅱ、Ⅲ、Ⅳ형담관협착적유효솔분별위95％ (57/60)、86％( 30/35)、9/14화1/2.29례환자방치가회수복막금속담관지가,82례방치소료담관지가.111례환자술후무엄중병발증발생,부6례발생경증급성이선염,경보수치료전유.내경치료1주후환자적피부점막황염、우상복압통、우상복창통、발열완해솔분별위73％ (81/111)、83％( 74/89)、90％ (73/81)화89％ (68/76)；술후8주상술지표완해솔분별위88％ (98/111)、91％ (81/89)、94％(76/81)화92％ (70/76).111례내경치료성공적환자중97례효과량호,14례효과흠가,전개복수술치료.술후6개월소유환자피부점막황염、우상복압통、우상복창통、발열등증상완전완해.결론 내경치료담도술후량성담관협착안전、유효.
Objective To investigate the efficacy of endoscopy for the treatment of benign biliary stricture after biliary surgery.Methods The clinical data of 127 patients with benign biliary stricture after biliary surgery at the First Hospital of Lanzhou University from January 2007 to December 2011 were retrospectively analyzed.According to the Bismuth classification,there were 60 patients with type Ⅰ,35 with type Ⅱ,21 with type Ⅲ and 11 with type Ⅳ.The efficacies of endoscopy for the treatment of biliary stricture with different Bismuth subtypes were analyzed.Results The location and severity of biliary stricture were confirmed by endoscopic retrograde cholangiopancreatography (ERCP) + cholangiography.Sixteen patients ( including 7 with type Ⅲ and 9 with type Ⅳ) were transferred to surgical treatment due to severe biliary stricture.A total of 111 patients underwent endoscopic treatment successfully,with the success rate of 87.4％ (111/127).The success rates of endoscopy for the treatment of patients with Bismuth Ⅰ,Ⅱ,Ⅲ and Ⅳ biliary strictures were 95％ (57/60),86％ (30/35),9/14and 1/2,respectively.Twenty-nine patients were implanted with retrievable metallic biliary stent,and 82 were implantated with plastic biliary stent.Of the 111 patients,only 6 patients were complicated by acute pancreatitis,and they were cured by conservative treatment.The alleviative rates of yellow skin and icteric sclera,tenderness and distending pain of right upper quadrant,fever were 73％ (81/111 ),83％ (74/89),90％ (73/81 ) and 89％(68/76) at 1 week after treatment,and they were 88％ (98/111),91％ (81/89),94％ (76/81) and 92％(70/76) at 8 weeks after treatment.The efficacy of endoscopy was good in 97 patients and poor in 14 patients,and the 14 patients were converted to open surgery.The symptoms including yellow skin and icteric sclera,tenderness and distending pain of right upper quadrant,fever were completely alleviated at postoperative month 6.Conclusion Endoscopic treatment for benign biliary stricture is safe and effective.