内镜治疗肝硬化合并胆总管结石的临床研究

目的探讨内镜治疗肝硬化合并胆总管结石的疗效及安全性。方法104例肝硬化合并胆总管结石患者行内镜治疗，对比术前、术后2周肝功能Child．Pugh分级和终末期肝病积分（MELD积分），记录并发症发生情况及死亡病例数。结果104例患者中96例（92．3％）完全取出结石，8例（7．7％）未取出结石者放置支架内引流。术后2周MELD积分为（10．1±6．3）分，明显低于术前的（11．9±6．2）分（t=2．22，P〈0．05）；术后2周肝功能Child—Pugh分级例数比（A级／B缈C级）为40／52／12，明显优于术前的28／52／24（X2=6．12，P〈0．05）。内镜治疗过程中无一例穿孔，发生术后消化道出血9例、术后胰腺炎8例；住院期间无死亡病例，出院后3个月内有2例（8．3％）Child—Pugh分级C级患者死亡。结论内镜治疗肝硬化合并胆总管结石有较好疗效，采取有效的预防和止血等措施后是安全可行的。

Endoscopic treatment of choledocholithiasis in patients with decomipensated cirrhosis

Objective To explore the safety and efficacy of endoscopic treatment for choledocholithiasis in patients with decompensated cirrhosis.Methods A total of 104 cases of choledocholithiasis with decompensated cirrhosis were treated by ERCP in our hospital between January 2001 and March 2011.ChildPugh grading and model for end stage liver diseases (MELD) were investigated pre-ERCP and 2 weeks post-ERCP.Complication and mortality during the follow-up were recorded.Results The success rates of complete stone retrieval was 92.3％ (96/104),and plastic stent was placed in other 8.Major complications ineluded post-ERCP bleeding in 9 cases (8.7％) and pancreatitis in 8 (7.7％ ).MELD score valuated 2weeks after ERCP ( 10.1 ± 6.3 ) was significantly lower than that of pre-ERCP ( 1 1.9 ± 6.2,t =2.22,P ＜0.05).The Child-Pugh grading before ERCP of 104 patients were 28 in grade A (26.9％ ),52 in grade B (50.0％ ) and 24 in grade C (23.1％ ),which was significantly different from those of 2 weeks after ERCP (40/52/12).No death was recorded during hospital stay for choledocholithiasis,and 2 patients of Child-Pugh grade C died in 3 months after discharge.Conclusion ERCP is an effective method for choledocholi-thiasis in patients with decompensated cirrhosis.The main severe complication was post-ERCP bleeding.Those patients with decompensated cirrhosis would benefit from ERCP if we took effective measures.