外科医生逆行胆管造影。

Gary C Vitale, Carlos M Zavaleta
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引用次数: 11

摘要

内镜逆行胰胆管造影仍然是胆道和胰腺疾病治疗的重要工具。内镜下切除胆总管结石是治疗结石残留的首选方法,也是胆囊原位手术前的常见选择。胆管炎的最佳治疗方法是内窥镜下括约肌切开术和支架置入术,并首先静脉注射抗生素,最终可能采用内窥镜下取石和/或扩张和支架置入术治疗狭窄。内镜下括约肌切开术也被推荐用于严重或迅速恶化的胆石性胰腺炎,或合并胰腺炎和胆红素升高或胆管炎的患者。恶性狭窄用内支架缓解是可能的,结果良好,与手术治疗相比,在疗效、并发症、死亡率和长期生存方面差别很小。胆道瘘管是很容易治疗的内镜支架置入,特别是当来源是胆囊管或副管。良性胆道狭窄可以长期扩张和支架置入,在选定的病例中取得良好的长期成功。胰腺支架置入术可用于治疗胰管狭窄和胰管高血压,并可显著改善疼痛。内镜下胰腺假性囊肿引流似乎是一种安全、有效和明确的治疗方法,在患者的解剖考虑允许其使用。总之,ERCP的治疗用途是普通外科医生的广泛兴趣,应该被外科社区理解和适当利用。
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Endoscopic retrograde cholangiopancreatography for surgeons.

Endoscopic retrograde cholangiopancreatography remains an important tool for the management of biliary and pancreatic disease. Endoscopic removal of common bile duct stones is the procedure of choice for retained stones and is a common option preoperatively with the gallbladder in place. Cholangitis is best treated by endoscopic sphincterotomy and stenting along with intravenous antibiotics initially with the possibility of definitive treatment with endoscopic stone removal and/or dilatation and stenting for strictures. Endoscopic sphincterotomy is also recommended in severe or rapidly worsening gallstone pancreatitis or in those with combined pancreatitis and rising bilirubin or cholangitis. Palliation with internal stents for malignant strictures has been possible with good outcome and very little difference in efficacy, complications, mortality, and long-term survival compared to surgical treatment. Biliary fistulae are easily treated by endoscopic stenting, particularly when the source is the cystic or an accessory duct. Benign biliary strictures can be dilated and stented for prolonged periods with good long-term success in selected cases. Pancreatic stenting is useful to treat pancreatic duct strictures and duct hypertension with considerable improvement of pain. Endoscopic drainage of pancreatic pseudocyst appears to be a safe, effective, and definitive treatment for patients in whom anatomic considerations allow its use. In summary, therapeutic uses of ERCP are of broad interest to the general surgeon and should be understood and utilized appropriately by the surgical community.

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