Sciumè C, Geraci G, Pisello F, Li Volsi F, Facella T, Modica G
Azienda Ospedaliero-Universitaria Policlinico Paolo Giaccone, Dipartimento di Chirurgia Generale d'Urgenza e dei Trapianti d'Organo, Sezione di Chirurgia Generale ad Indirizzo Toracico, Università degli Studi di Palermo.
Ann Ital Chir. 2004 Sep-Oct;75(5):531-5; discussion 536.
The aim of this study was to evaluate the effectiveness of endoscopic sphincterotomy and positioning of naso-biliary drain or biliary endoprosthesis for preoperative and postoperative complications of hepatic hydatid disease (fistuias, compressioni cholestasis, rupture in biliary tree).
During the period 1994-2003, 22 patients (12 male and 10 female, mean age 55.4 years, range 16-65 yrs) underwent endoscopic treatment for complications of hepatic hydatid disease. Indications for ERCP in 5 patients treated before surgery (Group A) were obstructive jaundice in ali, associated with acute cholangitis in 4 (80%) and acute pancreatitis in 1 (20%). In 17 patients treated after surgery (Group B), the indication was acute cholangitis in 6 (36%), obstructive jaundice 3 (17%), and persistent external drainage in 8 patients (47%).
In group A, ERCP detected hydatid vesicies within the bile duct in all patients. Ali patients underwent endoscopic sphincterotomy and clearance of the duct with no complications. The 8 patients in Group B with persistent external drainage had biliary fistulas that resolved after endoscopic treatment within 10 to 25 days (in 4 patients with low-flow fistula was positioned nasobiliary drain to repeat cholangiogram) or in 4-6 weeks (in 4 patients with high-flow fistula was positioned biliary endoprosthesis). In 2 of 8 patients (25%) with postoperative external biliary fistulas was observed choledocholitiasis (resolution with ERCP). Ali the 9 patients with postoperative obstructive jaundice or acute cholangitis, had cyst remnants obstructing the bile duct. Surgical reintervention was avoided in all patients in group B: all underwent endoscopic sphincterotomy and clearance of the bile duct without complications. After treatment, all patients remained asymptomatic.
Endoscopic sphincterotomy with positioning of naso-biliary drain or biliary endoprosthesis is a safe and effective treatment for preoperative and postoperative biliary complications of hepatic hydatid disease.
本研究的目的是评估内镜括约肌切开术以及鼻胆管引流或胆道内支架置入术对肝包虫病术前和术后并发症（瘘管、压迫性胆汁淤积、胆管破裂）的疗效。
在1994年至2003年期间，22例患者（12例男性，10例女性，平均年龄55.4岁，年龄范围16 - 65岁）接受了内镜治疗肝包虫病并发症。5例术前接受治疗的患者（A组）进行内镜逆行胰胆管造影（ERCP）的指征均为梗阻性黄疸，其中4例（80%）合并急性胆管炎，1例（20%）合并急性胰腺炎。17例术后接受治疗的患者（B组），指征为急性胆管炎6例（36%），梗阻性黄疸3例（17%），8例患者（47%）持续外引流。
A组中，ERCP在所有患者的胆管内均检测到包虫囊泡。所有患者均接受了内镜括约肌切开术和胆管清理，无并发症发生。B组中8例持续外引流的患者存在胆瘘，内镜治疗后10至25天（4例低流量瘘患者置入鼻胆管引流以重复胆管造影）或4至6周（4例高流量瘘患者置入胆道内支架）胆瘘得以解决。8例术后胆外瘘患者中有2例（25%）出现胆总管结石（经ERCP解决）。9例术后梗阻性黄疸或急性胆管炎患者，均有囊肿残余物阻塞胆管。B组所有患者均避免了手术再次干预：所有患者均接受了内镜括约肌切开术和胆管清理，无并发症发生。治疗后，所有患者均无症状。
内镜括约肌切开术联合鼻胆管引流或胆道内支架置入术是治疗肝包虫病术前和术后胆道并发症的一种安全有效的方法。
