Clinical Analysis Of Etiology And ERCP Diagnosis And Treatment Of Benign Lesions Of Bile Duct

Objiective:Through a retrospective analysis from 2010 to 2015 for ERCP diagnosis and treatment of 150 cases of benign terminal bile duct cholangitis in patients with clinical data of this study,to summarize the clinical features of benign terminal bile duct,Through the analysis of the risk of bile duct benign lesions at the end of follow-up after the treatment of ERCP recurrent cholangitis,ERCP evaluation of the treatment effect and determine the importance of the follow-up of the patients.Methods:Methods the clinical data of 150 patients with benign terminal bile duct lesions who were treated with ERCP from 2010 to were collected by using electronic case system in the First Affiliated Hospital of Bengbu Medical College.Inclusion criteria:To attack the right upper abdominal pain,bloating,anorexia as the main clinical manifestations,with or without fever,jaundice;⑶No stone was found inimaging examination.CT and MRCP showed dilatation of common bile duct and stricture of bile duct;⑷Excluding neoplastic lesions.The age,sex,history of cholecystectomy,gallbladder stones and diagnosis and treatment of ERCP were collected.Then analyze and summarize the clinical data.The postoperative complications such as hyperamylasemia,postoperative pancreatitis,biliary infection,bleeding and perforation were recorded;ERCP on the treatment of successful patients received telephone,outpatient visits etc,return time for a minimum of 3 months,the longest 6 years,including patients with postoperative recurrence of cholangitis symptoms,the recurrence rate of cholangitis and its risk factors were analyzed.Results:The average age of patients was 61.5±13.8(23-89)years old.There were 75cases of Cholecystectomy(n=75,50%)accounting for about 50%,20 cases of Cholecystolithiasis(n=20,13.3%),and13casesofAcute Pancreatitis(n=13,8.7%),78.7%of the patients had nausea,anorexia,90.7%patients had upper abdominal pain,27.3%patients with jaundice,49.3%patients had liver dysfunction,35.3%patients had elevated bilirubin,white blood cells increased suggesting that signs of infection accounted for 12.7%;The positive rate of CT and MRCP in the diagnosis of common bile duct dilatation with terminal stenosis was 74%,75.5%.The end of bile duct benign lesions including Commom bile duct Microlithiasis,duodenal papillitis,periampullary diverticulum,sphincter of Oddi dysfunction,These diseases may be present alone or in combination with each other.The clinical manifestations included right upper abdominal pain,skin and sclera jaundice,liver function and elevated bilirubin.There were 67 cases(44.7%)in which the disease existed alone,68 cases(45.3%)in the two diseases,15 cases in which the three diseases coexisted,accounting for 10.0%;Treatment of 150 patients,132 cases of success,intubation success rate was 88.0%;There were 28 cases of postoperative complications,the incidence rate of 18.7%,including the hyperamylasemia in 25 cases(16.7%),5(3.3%)cases of postoperative pancreatitis,4(2.7%)cases of biliary tract infection,gastrointestinal bleeding and no perforation,no deaths.Return result:There were 22cases of recurrent cholangitis after surgery,accounting for 17.5%,the operation within 3months after the reemergence of cholangitis symptoms in 4 cases,accounting for 3.2%,6 months after operation appeared cholangitis in 3 cases,accounting for 2.4%,8 cases,accounting for 6.3%of postoperative cholangitis in 1 years,7 cases of cholangitis is longer than 1 years,accounted for 5.6%.The average age of the recurrence group was64.9(SD13.6)years,higher than that of the non recurrent group at the age of 63.7(SD12.6)years,and the chisquare test for the factors associated with cholangitis,the difference of P<0.05 was statistically significant,The risk factors for recurrence of cholangitis were diverticula(X~2=5.188,P<0.05),un-cholecystectomy(X~2=8.591,P<0.05),EST(X~2=4.028,P<0.05),and cholecystolithiasis(X~2=5.75P<0.05),Logistic regression analysis showed that age,diverticulum,EST treatment were independent risk factors for recurrent cholangitis,cholecystectomy as a protective factor for recurrence.Conclusion:(1)The end of the bile duct benign lesions such as Commom bile duct Microlithiasis,duodenal papillitis,periampullary diverticulum,sphincter of Oddi dysfunction are lack of specific clinical symptoms,the clinical features of these patients were paroxysmal right upper abdominal pain,abnormal liver function and jaundice,and the imaging findings were the stricture of the bile duct and dilatation of the common bile duct and pancreatic duct.(2)The lesions often cause acute cholangitis,and has many kinds of diseases,the cross influence each other.(3)The diagnosis and treatment of benign lesions of the bile duct is difficult.ERCP has important diagnostic value for this kind of disease.ERCP has the advantages of good curative effect and few complications.(4)The characteristics of the terminal bile duct benign lesions with recurrence,age,combined diverticula and EST treated patients at high risk of postoperative recurrence of cholangitis,because of difficulties and early identification of malignant lesions,follow-up plays a very important role for the disease.