内镜对胆囊切除术后胆总管下端狭窄的诊断与治疗价值

Endoscopic management of distal stricture of common bile duct after cholecystectomy

目的:探讨内镜对胆囊切除术后胆总管下端狭窄的诊断及治疗价值。方法:89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38例(43%)胆总管下端狭窄患者行内镜下乳头括约肌切开术(EST)等内镜治疗。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94.74%、78.83%、88.75%,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%、92.69%、100%,术后所有患者血ALT,AST,ALP及GGT恢复正常。结论:EST是治疗胆总管下端狭窄有效和首选的治疗方法。

Objective： To study the clinical value of endoscopic management for patients with distal stricture of common bile duct （CBD） after cholecystectomy. Methods：The diagnosis of distal stricture of common bile duct was established in 38 out of 89 patients with postcholecystectomy syndrome by means of endoscopic retrograde cholangiopancreatography （ERCP）, and endoscopic sphincterotomies （EST） were performed for these patients. Results： Relief rates of abdominal pain in patients with simple stricture, stricture combined with acute pancreatitis and common bile duct stones were 94.74%, 78.83% and 88.75%, respectively, and the recovery rates of CBD diameter were 100%, 92.69% and 100%, respectively. Abnormal serum AST, ALT, ALP and GGT levels were resolved gradually in all patients after endoscopic management. Conclusion： EST is an effective treatment method for patients with distal CBD stricture after cholecystectomy.