应用内镜治疗26例胆囊切除术后的体会

26 Cases of Endoscopic Treatment of Biliary Complications after Gallbladder Removal Experience

目的探讨内镜在处理胆囊切除术后对胆管治疗中的作用。方法对胆囊切除术后出现腹痛等症状者行内镜下胰胆管造影(ERCP),对明确为胆管并发症者作以下治疗:①胆管残余结石行十二指肠乳头肌切开取石;②胆管部分狭窄行内镜胆管扩张后置内支架治疗;③胆总管完全横断继以外科手术治疗;④胆漏者行留置鼻胆引流管。结果26例并发症者中,胆管残余结石19例(占76%),结石均予以取出。胆总管部分狭窄2例(占8%),随访半年,2例均取得满意效果。胆总管完全横断1例(占4%),行外科手术。胆漏2例(占8%),内镜治疗后48h关闭。1例治疗失败,1例为十二指肠乳头肌功能不全,经乳头肌切开,症状缓解。结论胆囊切除术后临床上怀疑有胆管并发症,应尽早行ERCP检查,明确病因,予以相应治疗。

Objective To explore in dealing with endoscopic biliary complications after gallbladder removal of the role. Methods cholecystectomy symptoms such as abdominal pain after a trip to ERCP, to clear the bile duct complications following treatment ;① residual bile duct stone, to EST stones; ② nan：ow part of bile duct, bile duct endoscopy expansion of post-stent treatment; ③ complete transection of common bile duct,followed by surgery; ④ bile leakage to visit ENBD. Results 26 patients with complications,19 cases of bile duct residual stones （76 % ） ,the stones are to be removed. Common bile duct of the narrow two cases （8%）, followed up six months, two cases were achieved satisfactory results. Complete cross-sectional one case of common bile duct （4%） ,to surgery. Two cases of bile leakage （8%）, endoscopic treatment for 48 hours after the closure. Another one case of failure, one case of the duodenal papilla muscle dysfunction, the papilla tousle cut, ease the symptoms. Conclusion after cholecystectomy clinical suspected biliary complications, as soon as possible to ERCP examination, a clear cause, be treated accordingly.