ERCP在胆囊切除术后综合征病因诊断和治疗中的应用

The use of ERCP in the etiologic diagnosis and treatment of postcholecystectomy syndrome

目的评价ERCP在胆囊切除术后综合征（PCS）病因诊断和治疗中的应用价值。方法回顾性分析4年间收治的临床诊断为PCS的116例行ERCP患者的临床资料，对有治疗性ERCP指征的80例（68．97％）进行内镜治疗。结果全组116例胆管显影率为100％，胰管显影97例（83．62％）。PCS原因为胆总管结石56例（48．28％），十二指肠乳头旁憩室及憩室内乳头19例（16．37％）、胆囊管残留过长并胆囊管结石15例（12．93％），胆总管末端良性狭窄13例（11．20％）、Oddi’s括约肌运动功能障碍4例（3．45％），十二指肠乳头肿瘤3例（2．59％），胆总管损伤狭窄2例（1．73％），硬化性胆管炎1例（0．86％），胆管癌1例（0．86％），残留胆囊伴结石1例（0．86％）及慢性胰腺炎伴胰管结石1例（0．86％）。行EST取石57例次，内镜下鼻胆管引流治疗20例次，内镜下胆管内支架置放术治疗23例次，内镜下胆管内自膨性金属支架植入术治疗1例次，胰管括约肌切开取石1例次。未发生严重并发症。内镜治疗的80例中，75例获得随访3—12个月，74例（98．67％）症状缓解。结论ERCP是PCS病因诊断的金标准，PCS是ERCP治疗的适应证，对有内镜治疗指征的患者，治疗性ERCP是首选的方法。

Objective To evaluate the practical value of ERCP for etiologic diagnosis and treatment of postcholecystectomy syndrome （ PCS ）. Methods A retrospective review of 116 cases of postcholecystectomy syndrome received ERCP in the recent four years in our hospital was undertaken. Of the116 cases, 80 cases （ 68.97 % ） had the indications for therapeutic ERCP and were treated by endoscopy. Results The bile duct was visualized in all of the 116 cases （ 100 % ） , and the pancreatic duct was visualized in 97 cases （ 83.62 % ）. The etiology of PCS was choledocholithiasis in 56 cases （ 48.28 % ） , diverticulum adjacent to duodenal papilla or papilla with in the diverticulm in 19 cases （ 16.37 % ） , residual of long cystic duct with stones in 15 cases （12. 93 % ）, benign stenosis of terminal commom bile duct in 13 cases （ 11.20 % ） , sphincter of oddi dysfuction in 4 cases （ 3.45 % ） , tumour of doudenal papilla in 3 cases （ 2.59 % ） , stenosis of injured bile duct in 2 cases （ 1. 73 % ） , sclerosing cholangitis in one case （ 0.86 % ） , cholangiocarcinoma in one case （ 0. 86 % ） , remnant gallbladder with stones in one cases （ 0.86 % ） , and chronic pancreatic ductal lithiasis in one case （ 0.86 % ）. Fifty-seven cases were treated by EST stone extraction, 20 cases by ERBD, 23 cases by ENBD, 1 case by EMBE, and 1 case by EPS extraction. In the 80 cases treated with endoscopy ,75 cases were followed up for 3 - 12 months, with relief of symptons in 74 cases （98.67 % ）. Conclusions ERCP is the gold standard for etiologic diagnosis of PCS. PCS is an indication for therapy by ERCP. Therapeutic ERCP is the preferred treatment of PCS cases with an indication for endoscopic treatment.