ERCP在腹腔镜胆囊切除围手术期的应用

THE ROLE OF ERCP IN PERIOPERATIVE PERIOD OF LAPAROSCOPIC CHOLECYSTECTOMY

目的 探讨内镜 ERCP在腹腔镜胆囊切除围手术期的应用价值。方法 从 1998年 1月到 1999年 4月在 15 0 0例 L C病人中 ,有选择地进行术前 33例和术后 2 0例的 ERCP及内镜治疗 ,包括 EST,ENBD和网篮取石术。其指征为 :近期有胰腺炎发生或黄疸史 ,肝功能异常 ,碱性磷酸酶升高 ,B超或 CT示胆总管扩张或有结石 ,术中造影有胆管结石 ,术后有临床症状。结果 在术前33例 ERCP中 ,除 1例失败外 ,胆囊病变外的阳性发现有 12例 (37% ) ,而术后 2 0例的 ERCP中阳性发现有 14例 (70 % )。如以胆红素增高或 B超 CT示胆管结石为超选择性的 ERCP指征 ,其术前 ERCP阳性发现率可达 6 6 %以上。对胆总管结石 ,无论 L C术前、术后 ,内镜治疗成功率达 97～ 10 0 %。其并发症 2例 (3% )为轻型胰腺炎 ,经非手术治疗痊愈。结论 运用超选择性指征 ,可避免术前不必要的 ERCP。而术后一旦有临床症状 ,就应及时给予 ERCP内镜治疗。

Objective To explore the indication and the value of ERCP in perioperative phase of laparoscopic cholecystectomy.Methods From Jan.1998 to Apr.1999,a total of 1500 consecutive laparoscopic cholecystectomies were analyzed.The indication for preoperative group(n=33) included eleveted bilirubin level and alkaline phosphatase level,jaundice,pancreatits,live function abnormal,dilated bile duct and /or stone on ultrasound or CT.The indication for postoperative group(n=20)included clinical signs or symptoms,intraoprative cholengiography demonstrated common bile duct stone.Results Preoperative ERCP was performed in 32 patients(2.1%)and demonstrated abnormal in 12(37%).pstoperative ERCP was performed in 20 patients(1.3%)and demonstrated abnormal in 14(70%).Applying super-selected criteria for the indication of preoperative ERCP would predict more than 66% ductal stones.The EST and duct stones clearance were achieved in all 16 patiens with documented common bile duct stones.The morbidity was confined in two cases with self-limited pancreatits(3%).Conclusions Using“super-selected criteria”to select patients for preoperative ERCP can avoid unnecessary ERCP.As soon as postoperative patients have clinical signs or symptoms,endoscopic treatment should be performed timely.