腹腔镜胆囊切除术前选择性ERC的应用

Application of ERC in patients with gallstones and suspected duct stone before laparoscopic cholecystec-tomy

目的 探索ERC +LC对有症状胆囊结石和疑有胆管结石得治疗结果的选择性标准的研究。方法 回顾分析 2 0 0 1年 11月～ 2 0 0 3年 10月我科收治的胆石症患者中 2 0例先行ERC再行LC的情况。结果 本组病人ERC均获成功 ,ERCP +EST +ESE共取出结石 15例 ,B超等证实者 10例 ,胆总管直径 >8mm 12例 ,有黄疸史者 11例 ,肝功能异常者 11例 ,胰腺炎者 4例。ERC后平均 4 .6d行LC。随访 2月～ 2年未发现胆管残余结石。结论 严格掌握LC前行ERC适应症 ,对于减少不必要ERC率 ,避免LC后胆管残留结石都具有重要作用。

Objective To assess the effect and indication of endoscopic retrograde cholangiography (ERC) before laparoscopic cholecystectomy (LC) for symptomatic gallbladder and suspected duct stones. Methods Twenty patients with gallstones and suspected duct stones were reviewed. ERC was performed in all of the patients. Results All 20 patients received successful ERC, after ERC endoscopic extraction (ESE) and endoscopic sphincterotomy (EST), stones were cleared in 15 patients. Stones were found in 10 patients by brightness ultrasonic, common duct more than 8 mm in diameter in 12 patients, jaundice history in 11, abnormal hepatic function in 11, pancreatitis in 4. LC was performed after a median interval of 4.6 days. No stones were reported after a median follow-up of 6 months. Conclusions To reduce the unnecessary ERC and avoid residual stones after LC, the indications of ERC before LC should be stict.