医学论文-梗阻性黄疸行内镜下胆道内外引流的疗效观察.docVIP

医学论文-梗阻性黄疸行内镜下胆道内外引流的疗效观察 【摘要】? 目的 探讨术前内镜下胆道内外引流（ENBD和/或ERBD）对梗阻性黄疸患者进行治疗和术前准备的临床意义。方法 根据病因将胆道梗阻病例33例分为良性组（21例）和恶性组（12例）。33例患者实施急诊和择期引流的同时行胆道造影以明确诊断。结果 所有患者胆道均得到充分引流，急性胆管炎者胆道感染得以迅速控制，免于急诊手术；恶性组除2例晚期胰头癌患者仅行ERBD姑息治疗外，其余经ERBD或ENBD引流后，TB均降至40μmol/L以下，为手术创造了条件。全部行根治性手术，除1例出现肝残面胆瘘外，余无并发症发生，无手术死亡率。结论 术前ENBD和ERBD确有进一步的影像学诊断价值和微创其良好的胆道引流减压减黄效果，急诊床旁ENBD尤其对急性重症胆管炎及老年急性胆管炎的治疗具有特别重要的意义。 【关键词】? 梗阻性黄疸 鼻胆管引流术 胆管内支撑引流术 介入性 内镜检查 ??? 【Abstract】? Objective? To study the clinical significances of preoperational endoscopic nasobiliary drainage(ENBD) and/or endoscopic retrograde biliary drainage(ERBD). Methods? According to the cause, 33cases with biliary obstruction were divided into the benign group(n=21) and the malignant group(n=12). All cases in the benign group were performed with ENBD. In the malignant group, 2 cases were performed with ENBD, 2 cases were performed with ENBD and ERBD, the other 8 cases were performed with ERBD. Results? After the two groups were treated with ENBD and /or ERBD, biliary infection of the cases with acute cholangitis were controlled rapidly to avoid emergency operations, the cases with severe obstructive jaundice were palliated rapidly to improve their hepatic and renal functions. Except that 2 cases with advanced carcinoma of pancreatic head were only performed with ERBD for palliative treatment, all cases the total bilirubin(TB) were lowered40μmol/L, and performed with selective operations and recovered without any severe operative complications. Conclusion? ENBD and /or ERBD indeed have further imaged diagnostic value as well as the effect of minimal injury and better biliary drainage decompression to increase safety of the selective operations on the cases with biliary obstruction, therefore, they are worth applying. ??? 【Key words】? obstructive jaundice；ENBD；ERBD；internal support in choledochus；interventional ??? 随着内镜介入技术的不断提高，对梗阻性黄疸患者实施内镜下胆道引流正逐步被广大医务工作者和患者所接受。近3年来，我们对33例梗阻性黄疸患者实施了内镜下鼻胆管引流术（Endoscopic Nasobiliary Drainnage, ENBD）和内镜下胆管内支撑引流术（End