腹腔镜单纯胆囊切除术后胆道并发症的内镜治疗

Edoscopic treatment for bile duct complication following laparoscopic cholecystectomy

目的探讨十二指肠镜治疗腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)后胆道并发症的效果。方法胆管结石先行内镜下胆总管Oddi括约肌切开术(endoscopic sphincterotomy,EST)或内镜下乳头气囊扩张术(endosco picpapillary balloon dilatation,EPBD)后取石,胆总管上段狭窄行胆道扩张加支架置入术,胆漏、胆管横断者行内镜下鼻胆管引流术(endoscopic nasobiliary drainage,ENBD)或内镜下胆管内塑料支架引流术(endoscopic retrograde biliary drainage,ERBD)治疗。结果69例中,胆总管结石53例(76.7%),胆总管上段部分狭窄11例(15.9%),胆管横断2例(2.9%),胆漏3例(4.3%)。53例胆总管结石患者49例行EST后取石,4例因乳头较小行EPBD后取石。11例胆总管部分狭窄行胆道扩张术后放置内支架引流治疗,3个月后5例拔管造影未见明显狭窄结束治疗,6例狭窄未能完全解除者,再行胆管扩张及重新放置塑料内支架,均于9个月内恢复。2例胆管横断患者行ENBD后开腹手术治疗。3例胆漏患者用医用胶注射封堵漏口后行ENBD或ERBD后症状明显减轻,一周后缓解。结论LC后胆道并发症应早期行ERCP以明确诊断;十二指肠镜对LC后并发症的处理是一种好方法,优于其它检查和治疗。

Objective To explore the therapeutic effect of duodenoscopy on bile duct complications post laparoscopic cholecystectomy （LC）. Methods Bile duct stone was extracted by endoscopic sphincterotomy or endoscopic papillary balloon dilatation. Bile duct dilatation and endoprosthesis were performed for upper com- mon bile duct stricture, while bile leakage and bile duct transection were treated by ENBD or ERBD. Result Complications following LC occurred in 69 patients, consisted of residual bile duct stone in 53 patients （76.7%）, upper common bile duct stricture in 11 patients （15.9%）, bile leakage in 3 patients （4.3%）and bile duct transection in 2 patients （2.9%）. Forty-nine patients with residual bile duct stones were treated by EST and other 4 patients by EPBD. Eleven patients with upper common bile duct stricture were treated by bile duct dilatation and endoprosthesis. Among them, 5 patients did not have obvious stenosis after three months, while other 6 patients underwent bile duct dilatation and endoprosthesis again and recovered better in nine months. Surgery was performed on patients with bile duct transection after ENBD. Symptoms were relieved 1 week later in 3 patients with bile leakage sealed by Fibrin and followed by ENBD or ERBD. Conclusion Endoscopic therapy is a better approach for diagnosis and treatment of bile duct complications post laparoscopic cholecystectomy and superior to other management, especially in early stage.