摘要目的 探讨ERCP术中使用CO2在恶性肝门部胆管梗阻患者进行造影的安全性以及通过CO2造影指导引流的疗效.方法 前瞻、随机、对照分析北京友谊医院2008年9月至2010年2月间60例恶性肝门部胆管梗阻患者,分别在ERCP术中使用CO2气体造影、造影剂造影及对比MRCP无造影剂进行诊断和引流的疗效和安全性.结果 60例患者均一次置入支架或引流管成功,使用CO2造影在术后继发感染控制上要优于造影剂造影(P＜0.05),在引流效果上要优于对比MRCP无造影剂(P＜0.05).3组在引起术后胰腺炎或高淀粉酶血症上差异无统计学意义.结论 对于肝门部梗阻患者,ERCP时采用CO2造影是安全有效的,其术后白细胞升高情况要优于造影剂,引流成功率优于对比MRCP无造影剂,并且不会导致术后胰腺炎和高淀粉酶血症发生的增多.

abstractsObjective To explore the safety and efficacy of endoscopic retrograde cholangiopancreatography(ERCP)by using carbon dioxide for malignant biliary obstruction.Methods A total of 60 patients with malignant biliary obstruction, hospitalized from September 2008 to February 2010, were randomly divided into 3 groups to receive ERCP by using carbon dioxide, contrast agent or magnetic resonance cholangiopancreatography(MRCP)without any agent.The safety and efficacy of 3 contrast methods were compared.Results Successful stent or drainage tube insertion was achieved in all patients.Carbon dioxide was superior to contrast agent in terms of lowering postoperative infection rate(P ＜ 0.05), and it was also superior to MRCP for more effective drainage(P ＜ 0.05).There was no significant difference in occurrence of postoperative pancreatitis and hyperamylasemia between 3 groups.Conclusion Using carbon dioxide during ERCP, safe and effective, is superior to use of contrast agent in less leukocyte increase, and to MRCP in more adequate drainage in patients with malignant biliary obstruction.Furthermore, there is no more risk of pancreatitis and hyperamylasemia.