LC术前及术后联合应用ERCP和EST的体会

Application of ERCP and EST before and after Laparoscopic Cholecystectomy

目的探讨行内镜逆行胰胆管造影(ERCP)和内镜乳头括约肌切开术(EST)在腹腔镜胆囊切除术(LC)术前、术后的应用体会。方法回顾性分析选择性进行LC术前、术后ERCP及内镜治疗102例(包括EST,ENBD和网篮取石术等)的经验体会。结果术前行ERCP94例中,胆管显影89例,显影率94.6%,发现胆总管结石41例,乳头炎性狭窄21例,阳性发现率约65%,取石38例,成功率92.6%;术后行ERCP8例,胆管均显影,术后阳性发现8例,阳性率100%。其中2例胆漏、3例胆总管残石、3例乳头炎性狭窄,内镜治疗成功100%。对胆总管结石,无论术前、术后,内镜取石治疗成功率93%。ERCP并发症3例(2.8%)1例乳头出血,2例高淀粉酶血症,均用非手术治疗痊愈。结论ERCP和EST的应用是当前LC手术前、后诊断和治疗胆囊结石合并胆总管结石的最佳手段,对提高LC的成功率和减少LC的并发症,降低胆总管结石开腹手术的比率,均具有重要的作用。

Objective To evaluate the role of endoscopic retrograde cholangiopancreatography （ERCP） and endoscopic sphincterotomy （EST） before and after laparoscopic cholecystectomy （LC）. Methods Experience of using ERCP examination and FAST in 102 cases selectively undergoing LC before and after operation was retrospectively analyzed from 2003 to 2005. Results ERCP were performed in 94 cases before LC with the successful rate being 94. 6% （89/94）. The common bile duct disease was found in 65 % patients （62/94）, including 41 cases of common bile duct stone, 21 cases of inflammatory stenosis of papilla. EST was performed in these cases with the clearance rate of stone being 92.6%（38/41）. ERCP were performed in 8 cases after LC with the successful rate being 100 % （8/8）, including 2 cases of biliary leakages, 3 cases of common bile duct stone, 3 cases of inflammatory sterosis of papilla. The successful rate of endoscopic treatment was 100%. The common success rate of stone was 93%. Complication occurred in 3 cases, including l case of papilla bleeding and 2 cases of hyperamylesemia. All complications were cured with non-operating treatment. Conclusion ERCP and EST before and after LC is the best treatment and diagnosis method in gallbladder stone with common bile dust stone. It is very important to improve the success rate of LC, decrease complication and occurrence of the open operation of common bile duct stone.