摘要
OBJECTIVE: To assess the value of endoscopy in the etiological diagnosis and treatment of post-cholecystectomy syndrome (PCS).METHODS: 386 patients with PCS were given endoscopic retrograde cholangiopancreatography (ERCP).Having been made the etiology clear, patients with choledocholithiasis were subjected to endoscopicsphincterotomy (EST) or endoscopic papillary balloon dilatation (EPBD) to extract stones, those withpapillary inflammatory stricture to EST or EPBD, those with papillary diverticulum and sphincter of Oddidysfunction (SOD) to EPBD, those with papillary tumor and hepatobiliary tumor to endoscopic metalbiliary endoprosthese (EMBE), and those with biliary stricture in the mid bile duct, purulent cholangitis,choledocholithiasis (stones not extracted one time) and bile leakage to endoscopic nose-biliary drainage(ENBD).RESULTS: ERCP was performed successfully in 371 patients (96.1%). No abnormalities were foundendoscopically in 30 patients. In 243 patients with choledocholithiasis, 235 had stones removed after oneto three times. Thirty-nine patients with papillary inflammatory stricture were successfully treated withEST or EPBD. Nine patients with papillary diverticulum which oppressed the papillary opening and 7patients with SOD were also successfully treated with EPBD. In 16 patients with stricture in the mid bileduct, 11 showed improvement after ENBD. Six patients with papillary tumor and 5 patients withhepatobiliary stricture after EMBE showed significant alleviation of jaundice. Six patients with bileleakage caused by cholecystectomy received ENBD successfully, avoiding re-operation. Six patientsdeveloped gastroduodenal ulcer and 4 residual stones in the cholecystic duct. Complications occurred in 21patients (5.7%).CONCLUSIONS: ERCP may detect the etiology of post-cholecystectomy syndrome at early stage, andtherapeutic measures can be taken accordingly in clinical practice.
