ERP在胆胰疾病中的应用课件.ppt

胆管炎、胆囊炎防治措施 严格按规范消毒; 对引流不畅者置鼻胆管； 单支架引流效果欠佳的可行双支架置入； PTCD置入支架； 注意围术期应用广谱抗生素。 ERCP后脓毒血症 不彻底引流造成的胆管炎 肝脓肿 急性胆囊炎 胰腺假性囊肿的感染 脏腑穿孔后引起的感染 心内膜炎 预防ERCP后的败血症 抗生素预防: ciprofloxacin 增加胆管压力= 胆汁静脉反流 首先引流/分阶段确定性治疗 造影剂和胆汁的交换 恶性肝门阻塞; 常常不可能引流彻底 低氧血症和心血管意外 发生率1%。 危险因素大部分与患者的基础疾病有关。 术前须常规心电、血压、血氧饱和度监护； 有严重的低氧血症(Sa02 9 0%)及心血管事件应及时处理。 其他 取石网篮嵌顿； 碎石网篮断裂； 气胸、纵隔气肿； 肝脓肿、肠梗阻、结肠憩室穿孔； EST取石后胆管结石复发率增加。 美国消化内镜学会(American Society of Gastrointestinal Endoscopy,ASGE) 、美国国立卫生研究院(National Institutes of Health,NIH) ERCP临床应用指南 Gastrointest Endosc 2005,62∶1 2009年 中华医学会消化內镜分会ERCP学组 胆总管结石的ERCP诊治指南 胆管良恶性狭窄的ERCP诊治指南 胰腺疾病的ERCP诊治指南 预防高危因素 ERCP并发症不可怕 早期诊断 及早治疗 小结 ERCP在胆胰疾病的诊疗中发挥重要作用 ERCP是消化内镜中难度最大、风险最大手术 要严格掌握ERCP适应症和禁忌症 ERCP必须由经过严格训练内镜医师操作 要努力提高ERCP插管成功率，降低ERCP术后并发症 南医二附院消化病中心 The end 25 Xenical Slide Kit August 1998 Section 1 25 Slide 25: Psychological impact of obesity Obesity has a profound effect on the quality of life of the individual patient. The limitations imposed by musculo-skeletal, respiratory and cardiovascular disorders are frequently compounded by the psychological consequences of obesity (low self-esteem, depression and social isolation). Prejudice and discrimination add to the misery of the obese patient and contribute to the generally lower levels of academic achievement and employment opportunities amongst obese patients. The quality of life is made poorer by reduced sexual activity. 25 Xenical Slide Kit August 1998 Section 1 25 Slide 25: Psychological impact of obesity Obesity has a profound effect on the quality of life of the individual patient. The limitations imposed by musculo-skeletal, respiratory and cardiovascular disorders are frequently compounded by the psychological consequences of obesity (low self-esteem, depression and social isolation). Prejudice and discrimination add to the misery of the obese patient and contribute to the generally lower levels of academic achievement and employment opportunities amongst obese patients. The quality of life is made poore