腹腔镜胆囊切除术前逆行胆管造影的临床价值

Evaluation of endoscopic retrograde cholangiography prior to laparoscopic cholecystectomy

目的探讨在腹腔镜胆囊切除术 (LC)前 ,行内镜逆行胆管造影 (ERC)对判断胆总管并存病变的价值。方法对 43例病史中有黄疸、胰腺炎 ,肝功能异常 ,B超怀疑或证实胆管结石的患者 ,经ERC排除或取石后 ,再行LC。结果 43例ERC造影均获成功 ,ERC成功取出胆管结石 34例 ,LC成功 39例 (91 % )。术前有黄疸史 (P <0 0 1 ) ,胆总管扩张≥ 1cm(P <0 0 0 1 ) ,肝功能异常 (P <0 0 0 1 ) ,有胰腺炎史 (P <0 0 5) ,提示存在胆管结石。发生并发症 1例 (3 % ) ,无死亡。随访 1～ 3个月 ,未发现胆管残余结石。

ObjectiveTo assess the value of endoscopic retrograde cholangiography(ERC) before laparoscopic cholecystectomy(LC) for gallstone disease complicated by suspected cholelithiasis. MethodsIndications for ERC included history of jundice, pancreatitis,abnormal liver function, suspected or BUS proven cholelithiasis. ResultsA history of jaundice( P <0 01), CBD≥1?cm ( P <0 01), pancreatitis( P <0 01), abnormality of liver function( P <0 05), strongly suggests cholelithiasis. ERC was all successful in this study, CBD stones were removed in 34 cases by EST, with a complication rate of 3%, and without morbidity. LC performed after ERC and, or EST was successful in 39 out of 43 cases, and postoperative follow up of 1～3 months found no residual CBD stones. ConclusionsERC and, or EST before LC is a safe and effective therapeutic method for LC candidates with suspected concurrent cholelithiasis.