MRCP、ERCP在LC术前术后应用价值探讨  

Clinical value of MRCP and ERCP examination before and after laparoscopic cholecystectomy

作　　者：李启信[1] 卢业才[1] 束庆兵[1] 郭峰[1] 王光庆[1] 

机构地区：[1]安徽省巢湖市第一人民医院普外一科,238000

出　　处：《齐齐哈尔医学院学报》2009年第8期909-910,共2页Journal of Qiqihar Medical University

摘　　要：目的评价磁共振成像胆胰管造影(MRCP)在腹腔镜胆囊切除(LC)术前、术后检测胆总管结石的诊断价值及内窥镜逆行胆胰管造影(ERCP)在LC术后出现临床症状进一步诊断治疗的应用价值。方法对B超诊断胆囊结石可疑胆总管结石患者术前均行MRCP检查,LC术后半年内因症状持续存在行MRCP检查,对行MRCP未能发现结石的行ERCP检查、治疗。结果MRCP对胆总管结石诊断准确率明显高于B超。ERCP对LC术后胆总管结石治疗成功率为100%。结论非胆总管结石患者直接接受LC,胆总管结石可疑患者先行MRCP检查,阳性者进行开腹手术行胆囊切除+胆总管探查结合术中胆道镜检查治疗。术后出现临床症状怀疑结石或者胆瘘患者及时进行ERCP检查治疗。Objective To evaluate the value of Magnetic Resonance Cholangiopanereatography （MRCP） in diagnosing common bile duct stones before and after Laparoseopie eholecystectomy （LC）; and to investigate the role of Eneoscopie Retrograde Cholangio-Panereatography （ERCP） in management of postoperative recurrent symptoms. Methods For patients with gallbladder stones and suspected common bile duct stones, MRCP was uniformly used. Also, MRCP was performed for patients with continued symptoms lasted for postoperatively half a year. When no positive findings were reported by MRCP for symptomatic patients, ERCP examination was then applied. Results MRCP was more superior and accurate than uhrasonography in diagnosing common bile duct stones. The method of ERCP successfully managed the residual bile duet stones after LC, with a perfect cure rate of 100%. Conclusions For patients with gallbladder stones alone, LC is the preferred strategy; when complicated with suspected common bile duct stones, we suggest preoperative MRCP to make a differential diagnosis. However, when complicate common bile duct stones were diagnosed, open pholecystectomy combined with common bile duet exploration and intraoperative eholedochfiberseope must be taken. For those with residual bile duct stones or bile leakage, ERCP should be performed promptly.

关 键 词：腹腔镜胆囊切除术 磁共振成像胆胰管造影 内窥镜逆行胆胰管造影 胆总管结石 

分 类 号：R657.4[医药卫生—外科学] R735.8[医药卫生—临床医学]