神奇的微创取石---ERCP

随着微创时代的到来，不少疾病的手术治疗再也无须“大动干戈”。微创手术因创伤小、恢复快、并发症少等优势，成为不少患者的首选。

近日，一名八旬老人因突发腹痛、发热、黄疸等症状入住我院脾胃病科，通过抽血、影像学等检查，诊断为为胆总管结石合并胆道低位梗阻、化脓性胆管炎。经我科白光主任查看患者后，果断联系内镜中心、介入室、麻醉等团队，行ERCP取石术，取出了嵌顿在胆总管末端的结石。术后，该患者腹痛、黄疸等症状迅速缓解，观察3天后，拔出鼻胆管，出院。

左图为DSA显出的结石影

右图为经网篮取出的结石

ERCP内镜技术的一颗“明珠”

难度大、风险高、收益最大

ERCP是最为精细的消化内镜微创手术之一，难度大、风险高，但也是病人获益最大的一项内镜技术，故被誉为“内镜技术的一颗明珠”，其最大的优点就是微创，手术不经腹部，即不开刀，又叫不开刀的内镜下手术，故病人腹部无伤口。而且术后大部分病人恢复的非常快，一般患者住院7天左右就可以出院。

如此好的ERCP，究竟是一项什么技术呢？

ERCP又称经内镜逆行胰胆管造影术,手术是通过口腔经胃进入十二指肠降段，在乳头开口处插管，注入造影剂，在DSA下造影寻找病变，并予以治疗。

小视频

几分钟带你了解ERCP

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ERCP主要适应症：

1.胆总管结石诊断及治疗；

2.胆总管良恶性狭窄的诊断及治疗；

3.急性胆源性胰腺炎、胰腺占位、胰漏等疾病的诊治；

4.手术、外伤后胆瘘、胰瘘、胆管及胰管的狭窄；

5.十二指肠乳头、壶腹部肿瘤。

任何手术都有并发症，ERCP手术也有一定的并发症，最常见的并发症是术后的急性胰腺炎。大部分急性胰腺炎都是轻型胰腺炎，一般住院3-5天能够恢复。极少数是重症胰腺炎，发生率非常小，非常罕见。还有其他的并发症，比如出血或者穿孔等，发生率更低。随着内镜手术器械的发展和做ERCP手术医生技术的不断提高，ERCP手术后的并发症现在越来越少，非常微创且安全。

治疗胆总管结石

"ERCP"vs"传统手术"

胆总管结石在我国为常见多发疾病，传统治疗一般由外科行开腹胆总管探查取石及腹腔镜下胆道镜探查取石，术后置T管引流损伤较大，易造成胆道损伤和胆瘘等严重并发症,且微创优点不明显，再次开腹的机会大。传统的开腹手术或腹腔镜下胆管探查取石，手术时间长，住院时间长。

相对于传统手术，ERCP是一种微创介入治疗方法，治疗技术日趋成熟。十二指肠镜治疗胆总管结石具有微创、病人痛苦小、并发症少及死亡率低、恢复快、全身麻醉不需插管，具有安全、有效、简便、并发症少等优点，能保持胆管系统的完整性及生理功能。该技术不受多次手术后胆管周围粘连和病人年老体弱等限制，效果优于外科开腹手术，目前已成为治疗胆总管结石的首选方法，深受医务工作者及病人的青睐。

内窥镜中心

技术精湛诊疗规范

上世纪70年代，关文生教授完成了我院首例胃镜检查并组建消化内镜中心，随着世界消化内镜技术的不断发展，我院已形成具有一定规模的消化内镜诊治中心，现开展的诊治项目有：普通及无痛胃镜、结肠镜检查；异物取出术；内镜下食管静脉曲张硬化术（EIS）、内镜下食管静脉曲张套扎术（EVL）、胃内异物取出术、消化道出血的金属夹止血治疗、内镜下空肠营养管置入术、内镜下黏膜切除术（EMR）、内镜黏膜下剥离术（ESD）、经口内镜下肌切开术（POEM）、内镜下十二指肠乳头括约肌切开术（EST）、经内镜逆行性胰胆管造影术（ERCP）等，成为名副其实的“内镜中心”。

脾胃病科

不忘初心砥砺前行

辽医院脾胃病科经过半个多世纪的建设和几代名老中医的无私奉献，已成为国家中医临床重点专科，国家中医药管理局重点学科、十五、十一五、十二五重点专科、国家中医药管理局重点病种“消化性溃疡”协作组组长单位。科室积淀深厚，名医荟萃，英才辈出。不仅拥有造诣精深的名老中医，还拥有经验丰富、技术突出的中年骨干，更有基础扎实、勇于进取的后起之秀，形成了良好的专科人才梯队。先后涌现出了国医大师2名，全国名老中医师承指导教师3名，辽宁省名中医3名，全国优秀中医临床人才（小名医）3名，国家级名中医师承4名。科室现设有脾胃病专病门诊、病房、消化内镜诊治中心、脾胃病中医外治中心等。砥砺前行，再创辉煌！新的时代，新的征程，辽宁中医脾胃病科全体医护人员愿为您做身边最忠实的守护者，为您的脾胃保驾护航！

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北京哪里治疗白癜风的医院最好
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