胆囊切除术后胆总管下端狭窄的内镜诊断与治疗

Endoscopic management of down common bile duct postcholecystectomy

目的探讨胆总管下端炎性狭窄的内镜诊断与治疗。方法174例胆囊切除术后综合征患者行内镜下逆行胰胆管造影(ERCP),对发现的73例(41.95%)胆总管下端狭窄患者行内镜下治疗。结果上腹痛缓解率在单纯胆总管下端狭窄者、合并急性胰腺炎者、合并结石者分别为83.33%、73.81%、80.95%,胆总管内径恢复率在单纯胆总管下端狭窄者、合并急性胰腺炎者、合并结石者分别为100%、88.89%、100%,术后所有患者血ALT,AST,ALP及r-GT恢复正常。结论EST可作为治疗胆总管下端狭窄有效和首选的治疗方法之一。

To study the clinic value of endoscopic sphincterotomy(EST) in patients with stricture of down common bile duct postcholecystectomy. 73 patients with stricture of down common bile duct were found in 174 patients with postcholecystectomy syndromes through endoscopic retrograde chalongiopancreatography (ERCP), who were treated through endoscopic sphincterotomy (EST). 7 patients with pancreatitis and 9 patients with acute cholangitis were treated through endoscopic nosobiliary drainage (ENBD) after EST. Relief rate of abdominal pain was respectively 83.33%, 73.81%, 80.95% in patients with simple stricture of down common bile duct and patients with stricture of down common bile duct and acute pancreatitis and patients with stricture of down common bile duct and stones. The rate of normal common bile duct which was recovered was respectively 100%, 88.89%, 100% in patients with simple stricture of down common bile duct and patients with stricture of down common bile duct and acute pancreatitis and patients with stricture of down common bile duct and stones. Serium ALT and AST and ALP and r-GT was normal in all patients after EST. [Conclusions] EST is effective in treatment of patients with stricture of down common bile duct and is first means.