简易胆道测压法对胆囊切除术后综合征患者行EST的指导意义

Significance of Simple Biliary Manometry for Patients with Post-cholecystectomy Syndrome Receiving Endoscopic Sphincterotomy

目的探讨简易胆道测压法对胆囊切除术后综合征(post-cholecystectomy syndrome,PCS)行EST的指导意义。方法我院2011年1月~2015年12月对38例PCS经十二指肠镜胆道测压,压力升高者行EST,测量术后第1、2、3天胆管压力并观察症状缓解情况。结果胆道测压35例压力升高,压力为(2.47±0.37)k Pa,最高压力为2.92 k Pa,行EST治疗后胆道压力术后1 d下降为(1.23±0.37)k Pa,术后2 d下降为(1.09±0.32)k Pa,术后3 d下降为(1.15±0.34)k Pa,显著低于术前(P值均=0.000),不适症状消失,右上腹痛症状消失,随访6~24个月,平均13.7月,无症状复发。3例胆管压力未升高者给予心理治疗等辅助治疗后消化道和胆道症状逐渐缓解,腹痛发作频率逐渐下降,治疗后2周症状基本消失,电话随访半年,无症状复发。结论简易胆道测压法操作简便,对PCS病人行EST有重要指导意义,有利于胆道测压技术在更基层的医院开展。

Objective To investigate the significance of simple bi liary manometry for pa tien ts with post-cholecystectomy syndrome （PCS） recieving endoscopic sphincterotomy （EST）. Methods A retrospective analysis of medic al records of 38 patients diagnosed as PCS in our hospital from January 2011 to December 2015 was made. The patient’ s biliary pressures were measured through duodenoscopy. If the pressure rose above the normal, then the EST was implemented. The bile duct pressure was measured at 1,2, and 3 days after operation and the symptoms were observed. Results The bi le pre ssure test showed that 35 pa tients with elevated pressure, with the maximum pressure of 2. 92 kPa and the average pressure of （2. 47 ± 0. 37 ） kPa. After EST treatment, the bile duct pressures were （ 1.23 ± 0. 37 ） kPa on the first day, （ 1.09 ± 0. 32 ） kPa on the second day, and （ 1. 15 ± 0. 34 ） kPa on the third day, which were significantly lower than preoperative level （P = 0.000）. Discomfort symptoms and right upper abdominal pain symptoms disappeared. Follow-ups for 6-24 months （ average, 13.7 months） found no recurrence. Three cases without elevated bile duct pressure were given psychological and symptomatic treatment, and gastrointestinal and biliary symptoms were gradually relieved, with frequency of abdominal pain gradually decreased and symptoms disappeared after 2 weeks of treatment. Follow-ups by telephone for six months showed no recurrence. Conclusions Simple bi liary manometry is easy to carry out. It has important guiding significance for patients with PCS receiving EST. It is beneficial to carry out biliary manometry in preliminary hospitals.