内镜逆行胰胆管造影对腹腔镜胆囊切除术后再发胆源性腹痛的诊疗价值

Diagnosis and Treatment Value of Endoscopic Retrograde Cholangic Pancreatography to Recurrent Gallstone Abdominal Pain after Laparoscopic Cholecystectomy

目的探讨内镜逆行胰胆管造影（endoscopicretrogradecholangicpancreatography，ERCP）在腹腔镜胆囊切除术（1aparoscopiccholecystectomy，LC）后再发胆源性腹痛的诊断和治疗中的应用价值。方法对198例Lc后再发胆源性腹痛患者行ERCP明确病因后，对胆总管结石行内镜乳头括约肌切开术（EST）或经内镜乳头气囊扩张术（EPBD）后取石；对乳头狭窄者行EST或EPBD治疗；对胆总管中段狭窄者行内镜下鼻胆管引流（ENBD）或内镜下胆道塑料支架植入术（ERBD）治疗；对乳头肿瘤和胆管癌行ERBD治疗；对胆道蛔虫予以内镜下取虫术。结果191例（96．4％）ERCP获得成功。其中，胆总管结石102例，98例（96．0％）内镜下取石成功，平均取石1．3次。乳头狭窄35例，行EST14例，EPBD21例，其中20例行ENBD，症状改善后11例行ERBD治疗。胆总管中段狭窄12例，有10例行ENBD，后有7例行ERBD，其中3例置入2根支架。胆道蛔虫病9例均经内镜下取虫成功。胆管癌、壶腹癌行ENBD或ERBD，其中各有2例在黄疸减轻后转外科手术治疗。医源性肝胆管损伤1例行ERBD治愈，2例转外科手术治疗。结论ERCP能及早查明LC术后再发胆源性腹痛的确切病因，并予相应有效治疗，是一种创伤小、并发症少、准确性高、治疗效果好的诊治手段。

Objective To investigate the diagnosis and treatment value of endoscopic retrograde cholangic pan- creatography（ERCP） to recurrent gallstone abdominal pain after laparoscopic cholecystectomy （LC）. Methods 198 patients with recurrent gallstone abdominal pain after LC were examined by ERCP to determine their etiologies. Endo- scopic sphincterotomy （EST）or endoscopic papillary balloon dilatation （EPBD）was conducted to patients with choledo- cholithiasis;EST or EPBD was conducted to patients with papillary stenosis;endoscopic nasobiliary drainage（ ENBD ） or endoscopic retrograde bilioduodenal drainage （ERBD） was conducted to patients with choledochal stricture in the middle;ERBD was conducted to patients with papillary tumor or cholangiocarcinoma; Insects taken under endoscope was conducted to patients with biliary ascariasis. Results ERCP was conducted successfully in 191 patients （96. 4% ）. Calculi were taken under endoscope in 98 out of 102 （96.0%）patients with choledocholithiasis and the average frequency was 1.3. Of all 35 patients with papillary stenosis, EST was conducted in 14 patients and EPBD was conduc- ted in 21 patients,ENBD was conducted in 20 patients and ERBD was conducted in 11 patients after symptom im- proved. Of 12 patients with choledochal stricture in the middle, ENBD was conducted in 10 patients and ERBD was conducted in 7 patients with 2 stents in 3 patients. Insects were successfully taken under endoscope in 9 patients with biliary ascariasis. 2 patients with cholangiocarcinoma and 2 patients with ampullary carcinoma were turned to surgical therapy after jaundice remission. 1 patient with iatrogenic hepatic duct injury cured after ERBD ,and 2 patients turned to surgical therapy. Conclusion The etiology of recurrent gallstone abdominal pain after LC can be determined and corresponding effective treatment can be implemented by ERCP, which is a method of little trauma,less complication, high accuracy and good therapeutic effect.