胆囊切除术后残留胆总管结石的内镜诊治

Endoscopic Diagnosis and Treatment of CBD Residual Stones after Cholecystectomy

目的：探讨经内镜逆行胰胆管造影(ERCP)在胆囊切除术后残留胆总管结石诊治中的应用价值。方法：对胆囊切除术后腹痛、发热、黄疸或肝功能异常而经B超、CT或磁共振胰胆管造影(MRCP)证实或怀疑残留胆总管结石的患者进行ERCP检查,对发现胆总管结石的患者行EST或EPBD后取石。结果：ERCP检查的成功率为96．4%(108/112)。85例证实胆总管结石的患者行EST或EPBD后取石,79例(92．9%)取石治疗成功；6例因合并肝内胆管多发结石而行外科手术治疗。并发症发生率为4．5%,其中消化道出血2例,急性胰腺炎3例。结论：对于胆囊切除术后残留胆总管结石的患者,ERCP是理想的诊断方法,而且还可以同时进行治疗。

Objective：To study the efficacy of ERCP in the diagnosis and treatment of common bile duct （CBD） residual stones after cholecystectomy. Methods. ERCP were performed in these with confirmed CBD stones by ultrasonography, CT and MRCP or these with suspected CBD stones who suffered from abdominal pain, fever, jaundice and abnormal liver function after cholecystectomy. The patients with CBD residual stones were accepted endoscopic stones exclusion. Results： ERCP were successful in 108 of the 112 cases （96.4%）. 85 patients with CBD stones and 79 of them underwent stones exclusion after EST or EPBD. Other 6 cases with calculus of intrahepatic duct were treated by surgery after endoscopic diagnosis. The complications were found in 4.5% of these cases. Hemorrhage occurred in two cases and acute pancreatitis in 3 cases. Conclusion：ERCP are safe, simple and effective procedures for the diagnosis and treatment of CBD residual stones after cholecystectomy.