内镜下乳头括约肌切开术后急性坏疽性胆囊炎16例分析

Acute gangrenous cholecystitis after endoscopic sphincterotomy： a report of 16 cases

目的 探讨EST术后发生急性坏疽性胆囊炎（AGC）的原因和外科诊治。方法回顾性分析2003年6月至2007年1月开展的1066例EST患者的临床病理资料，对引起AGC可能的临床病理因素和治疗措施进行分析。结果16例患者EST术后并发AGC，发生率为1．5％，EST手术操作困难及胆道梗阻可能是急性坏疽性胆囊炎主要诱发因素。16例患者均成功进行急诊外科胆道手术治疗，无死亡病例。随访4～36个月，未再发现胆道感染、梗阻等症状。结论AGC发生可能是EST手术操作与胆道梗阻共同作用的结果，早期外科手术是治疗AGC的有效方法。

Objective To explore the causes and surgical management of acute gangrenous cholecystitis （AGC） after endoscopic sphincterotomy （EST）. Methods Clinical and pathological data of 1066 patients who underwent EST from June 2003 to January 2007 were analyzed retrospectively. Results AGC was complicated in 16 patients （ 16/1066, 1.5% ） , who underwent emergency operations and no death occurred. During the follow-up period of 4 to 36 months, no infection or obstruction was found. Conclusion Difficulty in EST manipulation and biliary obstrucion might play a leading role in AGC after EST, and early surgical intervention is effective.