胆源性胰腺炎胆总管探查的指征分析

Analysis of the indications of bile duct exploration in biliogenic pancreatitis

目的 探讨胆源性胰腺炎胆总管探查的指征。方法 回顾性分析我院两阶段胆源性胰腺炎胆总管探查的病例资料：1995年-1999年间的46例术前B超提示胆囊结石、胆总管结石、扩张或伴有黄疸。2001年-2006年间的30例术前B超提示胆囊结石、胆总管结石、扩张或伴有黄疸，并经过磁共振胰胆管成像（MRCP）筛检确认。结果 第一阶段术中探查及术后T管造影示无结石28例，占60．8％（28/46）。第二阶段术中探查及术后T管造影示无结石7例，占23．3％（7／30）。结论 根据B超显示胆总管扩张及黄疽而行胆总管探查的阴性率高（P〈0．05），胆源性胰腺炎应严格掌握胆总管探查指征，MRCP可无创性地显示胆总管系统，有助于胆源性胰腺炎是否行胆总管探查的决定。

Objective To explore and discuss the indications of bile duct exploration in biliogenic pancreatitis. Methods We retrospectively analyzed the medical records of the cases undergoing bile duct exploration for pancreatitis in our hospital during two periods 46 cases of cholecystolithiasis choledocholith and dilatation or presence of jaundice detected by preoperative ultrasonography during 1995 to 1999. 30 cases of cholecystolithiasis choledocholith and dilatation or presence of jaundice detected by preoperative ultrasonography, and confirmed by magnetic resonance cholangiopancreatography （MRCP） screening, during 2001 to 2006. Results No stones were found at intraoperative bile duct exploration and postoperative choledechography via the T-tube in 28 cases （60.8%,28/46）during the first period, compared with 7 cases （23.3%,7/30） during the second period. Conclusions There is a high negative rate of stones in bile duct exploration in the cases of CBD dilatation and jaundice based on ultrasonographic findings（P〈0.05）.Indication for bile duct exploration in biliogenic pancreatitis should be strictly controlled. MRCP is available to reveal the biliary system non-invasively, helping to decide if bile duct exploration should be performed in biliogenic pancreatitis.