经内镜逆行胰胆管造影与乳头球囊扩张术在胆囊切除术后综合征诊治中的应用价值

The value of ERCP and EPBD in patients with postcholecystectomy syndrome

[目的]探讨经内镜逆行胰胆管造影(ERCP)与乳头球囊扩张术(EPBD)在胆囊切除术后综合征(PCS)中的临床应用价值。[方法]2008年7月～2011年6月间经ERCP与EPBD诊断和治疗的PCS患者57例,分析应用情况。[结果]55例(96.5%)成功实施ERCP,2例未成功者均为壶腹部肿瘤破坏乳头,经取活检明确病因。57例中未明确病因4例(7.2%),胆总管结石24例(42.1%),均经一次内镜取净结石;胆管中段狭窄6例(10.5%)、乳头炎性狭窄6例(10.5%),乳头旁憩室5例(8.8%),均行EPBD治疗成功;胆囊管残留过长及伴有残留结石4例(7.2%),行EPBD后效果不满意转外科手术治疗;壶腹部肿瘤4例(7.2%)转行外科手术治疗;胃十二指肠溃疡3例(5.3%),胰腺癌1例(1.8%)。ERCP与EPBD治疗后并发症发生率为3.5%。[结论]ERCP与EPBD能及时明确PCS的病因,予以及时治疗。

[Objective]To assess the applied value of endoscopic retrograde cholangio-pancreatography （ERCP） and endoscopic papillary balloon dilation （EPBD） in patients with postcholecystectomy syndrome （PCS）. [Methods]Fifty-seven patients diagnosed PCS were given ERCP and EPBD to clarify the precise causes of the problems between Jul. 2008 and Jun. 2011. [Results]ERCP and EPBD were successfully performed in 55 cases with a success rate of 96.5 %. Two failed cases were performed biopsy and then were clarified as papil- lary tumor. Four patients had no abnormal endoscopic finding. 24 cases were choledocholithiasis under EPBD. Six cases with stricture in the middle choledochus, six cases with papillary inflammatory stricture and five cases with papillary diverticulum were all successfully treated with EPBD. Four cases of papillary tumor and four cases with residual stones in cholecystic duct were transferred to surgery. Three cases were diagnosed as gastroduodenal peptic ulcer. One case was pancreatic cancer. The overall ERCP and EPBD re- lated complication rate was 3.5%[Conclusion3ERCP and EPBD have a high accuracy on the evaluation of the causes of PCS and play an important role in diagnosis and treatment of PCS.