内镜逆行胰胆管造影术在肝包虫病胆道并发症治疗中的应用*

Application of ERCP in treatment for biliary complications of hepatic hydatid disease*

摘要:

：目的 探讨内镜逆行胰胆管造影术（ERCP）在肝包虫胆道并发症治疗中的价值。方法 回顾分 析该院2010 年10 月-2016 年10 月ERCP 参与治疗的肝包虫病27 例，总结患者的临床表现、实验室检验、 影像学检查、手术方式及治疗效果。结果 该组有27 例应用ERCP 参与治疗的肝包虫胆道并发症病例。其中， 12 例因肝包虫囊肿破入胆道引起急性化脓性胆管炎及梗阻性黄疸，7 例因肝包虫囊肿压迫胆总管引起重度黄 疸，先行ERCP 通畅胆道引流，择期行开腹手术；6 例因肝包虫内囊摘除术后残腔胆瘘，2 例因肝包虫术后胆 道狭窄，术后行ERCP 放置胆道支架，该组27 例均取得良好的治疗效果；比较患者术前24 h 内与术后48 h 白细胞计数（WBC）、谷草转氨酶（AST）、谷丙转氨酶（ALT）、总胆红素（TBIL）、碱性磷酸酶（ALP）和 γ- 转肽酶（GGT）6 项指标，术后均有改善，差异有统计学意义（P <0.05）。结论 对于肝包虫病引起的急 性化脓性胆管炎、胆瘘和胆道狭窄等胆道并发症，在术前或术后采用ERCP 处理具有重要的诊治价值。

Abstract:

Objective To evaluate the role of endoscopic retrograde cholangiopancreatography (ERCP) in treatment for biliary complications of hepatic hydatid disease. Methods From October 2010 to October 2016 , 27 patients who were admitted for hepatic hydatid disease underwent therapeutic ERCP pre- or post-operation, then we retrospectively analyzed the clinical manifestations, laboratory tests, imaging examinations, ERCP methods and therapeutic effects in perioperative period of ERCP. Results All the 27 patients who underwent ERCP pre-or postoperations because of biliary complications of hepatic hydatid disease obtained good treatment effect. There were some reasons for ERCP, 12 cases for acute suppurative cholangitis and obstructive jaundice caused by intrabiliary rupture and 7 for severe jaundice compress by large hepatic hydatid cyst, whereas 6 cases for biliary fistula and 2 for biliary stricture after operation. 6 indexes including white blood cell count (WBC), aspertate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TBIL), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT) were significantly different between 24 hours pre- and 48 hours post- ERCP (P < 0.05), all the patients were improved after operation. Conclusion ERCP which is performed at pre- or post- operation may be an effective treatment for biliary complications of hepatic hydatid disease such as acute suppurative cholangitis, biliary fistula and stricture.