摘要
目的 :探讨内镜在处理胆囊切除术后胆道并发症中的作用。方法 :自 1997年 1月至 2 0 0 0年 11月间 ,对胆囊切除术后出现腹痛和黄疸患者行ERCP ,胆囊切除术后行ERCP的平均时间为 95天。对明确为胆道并发症者 ,作以下治疗 :①对于胆道残余结石 ,行EST或EPBD后取石。②对于胆管部分狭窄者 ,用内镜胆道扩张和内支架治疗。③对于胆总管完全横断者 ,行ERBD后继以外科手术。④对于胆漏者 ,行EST和ENBD治疗后辅以经皮腹腔引流。结果 :2 2 4例胆道并发症者中 ,胆道残余结石 16 9例 (占 75 .4% ) ,16 5例结石排出。胆总管部分狭窄 37例 (占 16 .5 % ) ,随访 1年 ,2 5例均取得满意效果。胆总管完全横断 12例 (占5 .4% ) ,7例行ERBD ,待黄疸减退后全部行外科手术。胆漏 6例 (占 2 .7% ) ,5例避免再次外科手术 ,1例内镜治疗后 2天症状无减轻而接受手术治疗。结论 :胆囊切除术后临床上怀疑有胆道并发症 ,应尽早行ERCP检查。内镜对胆道残余结石和小的胆漏的疗效确切 ,对胆道部分狭窄的患者 ,首选内镜内支架治疗。
Objective:To evaluate the value of endoscopy in the management of biliary complications after cholecystectomy.Methods:Patients with abdominal pain and jaundice after cholecystectomy were referred for ERCP between Jan.1997 and Nov.2000. The mean time between cholecystectomy and ERCP was 95 days. Those with definite biliary complications were given following therapies:①Residual stones in the common bile duct were retrieved after EST or EPBD.②Those with partial biliary stricture were given biliary dilatation and endoscopic stenting.③ERBD and operations were managed for those with complete biliary severance.④Those with bile leakage were given EST, ENBD and supplementary percutaneous abdominal drainage.Results:Of 224 cases with biliary complications,169 patients(75.4%) had residual stones in the common bile ducts and stones in 165 patients were removed totally. 37 patients(16.5%) had a partial biliary stricture with a satisfactory outcome in 25 patients after one year follow up. Of 12(5.4%) complete biliary severance with operations after endoscopy,7 patients had ERBD and jaundice had dropped significantly. 6 patients (2.7%) had bile leakage and 5 did not need another operation after endoscopic therapy.Conclusion:ERCP is indicated early when a biliary complication is suspected clinically after cholecystectomy,especially in those with abdominal pain and jaundice. Endoscopy is effective for the treatment of residual stones and bile leakage. Endoscopic stenting may be offered as a primary option for those with partial biliary stricture.
出处
《肝胆胰外科杂志》
CAS
2001年第4期184-186,共3页
Journal of Hepatopancreatobiliary Surgery
关键词
内镜
胆囊切除术
并发症
endoscopy
cholecystectomy
complication
