内镜对胆石症术后患者的诊断和治疗价值  

Diagnostic and therapeutic value of endoscopy on post-operative cholelithiasis patients

作　　者：康生朝[1] 吴汉平[1] 贺月[1] 魏红梅[1] 张方信[1] 

机构地区：[1]兰州军区兰州总医院消化内科,甘肃兰州730050

出　　处：《西北国防医学杂志》2009年第6期432-434,共3页Medical Journal of National Defending Forces in Northwest China

摘　　要：目的:探讨内镜对胆石症术后患者的诊治价值。方法:对185例胆石症术后患者行ERCP明确病因后,胆管结石行内镜乳头括约肌切开术后取石;怀疑Oddi括约肌功能障碍(SOD)者行乳头小切开;胆漏患者行ENBD(鼻胆管引流)或ERBD(胆道塑料支架置入)。确诊胆总管占位行ERBD或EMBE(胆道金属支架置入)。结果:182例(98%)ERCP成功。135例胆道结石成功取石。胆漏7例,5例行ENBD,2例行ERBD,SOD15例予乳头括约肌小切开。胆囊管结石3例,行ENBD。10例胆管肿瘤行EMBE 8例及ERBD 2例。胆总管截断2例转外科治疗。胆道系统正常10例。术后3例并发急性胰腺炎,4例并发上消化道出血,总的并发症发生率4.3%。结论:内镜下ERCP能明确胆石症术后患者的病因,同时可给予相应的内镜治疗。Objective：To investigate the diagnostic and therapeutic value of endoscopy on post-operative cholelithiasis patients.Methods：ERCP were performed in 185 cases of post-operative cholelithiasis to identify the diagnosis.EST（endoscopic sphincterpapillotomy） and stone extraction were performed in patients with calculus of bile duct.Minor cut of papilla were performed in patients suspected SOD.ENBD（endoscopic nasobiliary drainage） or ERBD（endoscopic retrograde biliary drainage） were performed in bile leak patients.ERBD or EMBE（endoscopic metal biliary endoprothesis） were performed for the patients with cholangiocarcinoma.Results：ERCP were succeeded in 182 cases（98%）.Stones were successfully removed in 135 patients with calculus of bile duct.ENBD（5 cases） and ERBD（2 cases） were performed in 7 bile leak patients.Minor cut of papilla were performed in 15 cases of SOD.ENBD were performed in 3 cases of cyst duct stones.EMBE（8 cases） and ERBD（2 cases） were performed in 10 cases of cholangiocarcinoma.Two patients with transected common bile duct needed surgical intervention.The bile tree was normal in 10 patients.Acute pancreatitis occurred in 3 patients and upper gastrointestinal bleeding occurred in 4 patients.The overall complication rate was 4.3%.Conclusion：ERCP may not only identify the disease causes of post-operative cholelithiasis patients,but also provide the proper endoscopic therapies.

关 键 词：胆石症 术后 内镜 逆行胰胆管造影 

分 类 号：R657.42[医药卫生—外科学]