内镜在胆囊切除术后综合征病因诊断和治疗中的应用价值

Applied value of endoscope in etiologic diagnosis and treatment following cholecystectomized problem

目的 :探讨内镜在胆囊切除术后综合征病因诊断和治疗中的应用价值。方法 :对 86例胆囊切除术后综合征病人行ERCP检查明确病因后 ,对胆管结石者行EST和EPBD后取石 ;对乳头炎性狭窄者行EST或EPBD治疗 ;对乳头旁憩室压迫乳头开口和SOD者行EPBD治疗 ;对乳头肿瘤和肝门胆管癌行EMBE ;对化脓性胆管炎 ,继发性胆总管多发结石、结石难以一次取净及术后胆瘘、胆管中段狭窄者行ENBD。结果 :83例(96 .5 % )ERCP成功。未发现异常 7例。胆管结石 4 5例 ,其中 4 1例经 1～ 3次内镜取石后取净。乳头炎性狭窄 4例 ,经EST或EPBD治疗 1次成功。乳头旁憩室压迫乳头开口 7例 ,SOD 2例 ,行EPBD治疗 1次成功。胆管中段狭窄 4例 ,2例行ENBD成功。乳头肿瘤 4例 ,肝门胆管狭窄 5例 ,行内支架治疗后黄疸减退。胃十二指肠溃疡 3例。胆囊管结石残留 2例。总的并发症发生率 6 .97%。结论 :ERCP能及早发现胆囊切除术后综合征确切病因并给予相应内镜治疗。

Objective:To evaluate the applied value of endoscopy in etiological diagnosis and treatment following cholecystectomized problem.Methods:Eighty-six patients with cholecystectomized problem were given ERCP. After the etialogy had been clear,EST or EPBD was performed on those with choledocholithiasis to take out stones,EST or EPBD on those with papillary inflammatory stricture,SOD on those with papillary diverticulum,SOD,EMBE on those with papillary tumor and hepatobiliary tumor,and ENBD was used for those with blilary stricture in middle segment,purulent cholangitis,chloedocholithiasis (stones could not be taken out in one time) and bile leakage.Results:ERCP was succeeded in 83 cases(96.5%). Seven cases had no abnormal endoscopic view. Forty-five cases suffered from choledocholithiasis,of whom,stones in 41 cases were totally get rid of after one to three times. Four cases with papillary inflammatory stricture were given EST or EPBD successfully in one time. Seven had papillary diverticulum which oppressed papillary hole,2 had SOD,all of whom were dealt with EPBD. Four had stricture in the middle segment of the bile duct,2 of whom were handled with ENBD. Four papillary tumor patients and 5 hepatobiliary stricture patients received EMBE and jaundice dropped significantly following internal stent. Three cases suffered from gastroduodenal ulcer. Residual stones in cholecystic duct were seen in 2 cases. Total incidence of complications were 6.97%.Conclusion:ERCP can find the defenite cause following cholecystectomized problem at early stage and corresponding endoscopic therapeutic measures.