腹腔镜胆囊切除术前、术后选择性应用逆行胰胆管造影诊断及治疗的价值

The value of selective ERCP in diagnosis and treatment before and after laparoscopic cholecystectomy

目的 探讨腹腔镜胆囊切除术前、术后选择性应用逆行胰胆管造影（ＥＲＣＰ）诊断及治疗的价值。方法 在腹腔镜胆囊切除术（ＬＣ）术前对疑有胆系疾病的１２７例病人及ＬＣ术后仍有临床症状的３７例病人行ＥＲＣＰ及内镜治疗。结果 发现胆管扩张及胆管结石４６例，乳头狭窄１２例，乳头水肿１３例，胆道蛔虫３例，十二指肠憩室１８例，胆管正常７２例，并同时行内镜治疗。结论 ＬＣ术前选择性应用ＥＲＣＰ可明确诊断，对部分病人经内镜治疗后可扩大ＬＣ手术适应证范围。ＬＣ术后应用ＥＲＣＰ可对仍有临床症状的病人发现原因，及时治疗，但需妥善选择病例，熟练掌握技术可减少ＥＲＣＰ的并发症。

Objective To study the value of selective ERCP in diagnosis and treatment before and after laparoscopic cholecystectomy.Methods We study the 127 cases of patients with preoperative uncertain biliary diseases and 37 cases with postoperative clinical symptoms,who were performed by endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic therapy.Results We found that there were 46 cases with cholangiectasis and CBD stones,12 cases with papillary stenosis,13 cases with papillary edema,3 cases with biliary ascariasis,72 cases with duodenocysts and 18 cases normal.All the patients were treated endoscopically.Conclusions We think that selcetive preoperative ERCP can identify the diagnosis of the diseases in the biliary system and thus extend the indication of LC for some patients after endoscopic therapy.Postoperative ERCP can be used to find out the etiology of the patients with clinical symptoms,and is good for immediate treatment.The complications of ERCP can be decreased by skillful operation and rationally choosing operative candidates. [