Vai trò của ERCP trong bệnh lý đường mật

Biliary pancreatic ducts diseases are very common in Vietnam. Besides stones in biliary tract, Ascaris lumbricoides in bile ducts, gallstone pancreatitis, tumors of pancreatic head, cholangiocarcinomas, periampullary diseases, complications induced by biliary surgery are usually found. Up to now, traditional textbooks of Vietnamese medical universities has taught to medical students that all of these diseases need surgery. However, in many countries with advanced medicine, also in Vietnam recently, ERCP is a revolution in medicine, not only being of high value in diagnosis but also treating almost all biliary pancreatic diseases without the help of surgery. In 06 months first half year 2011 at Nguyen Tri Phuong hospital, we have had 120 patients. It is thanks to this technique that the patients no need surgery. Morever, ERCP gives a high percentage of correct diagnosis 97 percent. Of all common bile duct (CBD) stones, we succeed in extracting 95 percent, of which 10 percent combine with gallstones removed by laparoscopic cholecystectomy later, and 30 percent combine with intrahepatic stones removed by endoscopic route with high success rate. The authors have five cases after ES but can not stones extraction by ERCP because these big stones have had opened choledotomy but we did not use Kehr tube after removed these big stones from the CBD. In terms of cholangiocarcinomas and tumors of pancreatic head, according to .medicallitterature, radical surgery can be performed in only 10 percent of these diseases and 5 year survival rate does not exceed 1 percent, especially in hilar cholangiocarcinomas surgery seems hopeless and almost all are palliative methods. Conversely, by ERCP, The authors are successful in stenting 80 percent of head pancreatic tumor or cholangiocarcinomas at all sites for biliary obstructive palliation. And also succeed in stenting almost all biliary fistulas, biliary strictures due to surgery, and biliary obtruction due to stones. In sphincterotomies, all of which were used for stone extraction and for Oddi stenosis without surgical sphincteroplasty as performed formerly. So, this technique shows its advantages as a non-operation method. The patient do not pass painful post-op stage, no need general anesthesia, and stay in hospital only in 1-2 days. The authors find that in Nguyen Tri Phuong Hospital, ERCP plays an important and leading role in diagnosis and treatment of biliary pancreatic diseases, which can replace surgery. This overview is a red spot in medical practice of the hospital, a special impression on surgeons, and also an impulse to change the viewpoint in providing medical knowledge for students in medical universities about biliary ducts diseases.