Simşek Halis, Ozaslan Ersan, Sayek Iskender, Savaş Cemil, Abbasoğlu Osman, Soylu Ali Riza, Balaban Yasemin, Tatar Gonca
Department of Internal Medicine, Division of Gastroenterology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Gastrointest Endosc. 2003 Sep;58(3):384-9. doi: 10.1067/s0016-5107(03)00013-0.
This retrospective study evaluated the use of diagnostic and therapeutic ERCP in pre- and postoperative patients with hepatic hydatid disease.
For 8 years, ERCP was performed in 39 patients with hepatic echinococcal disease. Indications in the preoperative group of patients (n = 19) included a cholestatic enzyme profile in all cases; jaundice or acute cholangitis also was present in, respectively, 14 and 7 cases. In the postoperative group (n = 20), indications for ERCP included persistent external biliary fistula after surgery in 10 patients, jaundice in 8, acute cholangitis in 7, and right upper quadrant pain in 2 patients.
ERCP findings in the preoperative group included cystobiliary fistula (9 patients), external compression of the hepatic biliary system (5), hydatid vesicles and/or membranes within the biliary tract (3), intrahepatic duct stricture (1), and a normal cholangiogram (4). The most common ERCP finding in the postoperative group was external biliary fistula (10 patients); other findings consisted of hydatid cyst material within the bile duct (4), bile duct stenosis (2), cystobiliary fistula and hydatid cyst material in the bile duct (1), cystobiliary fistula (1), hydatid membranes in the gallbladder (1), extrinsic compression to bile ducts (1), and a normal cholangiogram (1). In the preoperative group, endoscopic sphincterotomy was performed in 11 patients, with balloon catheter extraction in 2; complete resolution of findings was achieved in 10 cases. In the postoperative group, sphincterotomy (with balloon or basket extraction as needed) was performed in 19 patients, stents were placed in 2 patients, 1 patient underwent balloon dilatation, and 1 had nasobiliary drainage; there was complete resolution of the findings in 14 of the 20 patients.
ERCP and related therapeutic maneuvers are safe and valuable in the pre- and postoperative management of patients with hepatic hydatid disease.
这项回顾性研究评估了诊断性和治疗性内镜逆行胰胆管造影术（ERCP）在肝包虫病患者术前和术后的应用。
在8年时间里，对39例肝棘球蚴病患者进行了ERCP检查。术前组患者（n = 19）的适应证包括所有病例均有胆汁淤积酶谱异常；分别有14例和7例出现黄疸或急性胆管炎。术后组（n = 20）中，ERCP的适应证包括10例患者术后持续性外胆管瘘、8例黄疸、7例急性胆管炎以及2例右上腹疼痛。
术前组ERCP检查结果包括胆囊胆管瘘（9例）、肝内胆管系统外部压迫（5例）、胆管内包虫囊泡和/或膜（3例）、肝内胆管狭窄（1例）以及胆管造影正常（4例）。术后组最常见的ERCP检查结果是外胆管瘘（10例）；其他结果包括胆管内包虫囊肿物质（4例）、胆管狭窄（2例）、胆囊胆管瘘和胆管内包虫囊肿物质（1例）、胆囊胆管瘘（1例）、胆囊内包虫膜（1例）、胆管外部压迫（1例）以及胆管造影正常（1例）。术前组中，11例患者进行了内镜括约肌切开术，2例进行了球囊导管取出术；10例患者的检查结果完全缓解。术后组中，19例患者进行了括约肌切开术（根据需要进行球囊或网篮取出），2例患者放置了支架，1例患者接受了球囊扩张，1例患者进行了鼻胆管引流；20例患者中有14例的检查结果完全缓解。
ERCP及相关治疗操作在肝包虫病患者的术前和术后管理中是安全且有价值的。
