十二指肠镜在胆囊切除术后的应用  

Application of endoscopy in postcholecystectomy syndrome

作　　者：丁生财[1] 梁平[1] 李靖[1] 王细文[1] 刘锡能[1] 左国华[1] 黄小兵[1] 高明发[1] 李洪艳[1] 

机构地区：[1]第三军医大学新桥医院肝胆外科,400037

出　　处：《消化外科》2004年第3期175-177,共3页Journal of Digestive Surgery

摘　　要：目的　通过分析 12 4例胆囊切除术后综合 (PCS)征临床资料 ,探讨PCS的病因和诊断方法以及评价ERCP的诊断价值。方法　对 12 4例临床诊断为PCS的患者行B超、胃镜或上消化道钡餐检查 ,以明确病因。结果　 12 4例患者插管 ,成功率 93 5 % ,胆管结石 6 8例 ,胆管扩张 4 7例 ,胆管狭窄2 6例 ,胆囊管残留过长及残余小胆囊 11例 ,十二指肠乳头憩室内或憩室旁开口 11例 ,胆道未见异常2 3例 ,非胆道疾病 15例。结论　PCS最为常见的病因为胆管结石和胆管狭窄 ,其他较为少见原因包括十二指肠憩室、Oddi括约肌运动功能障碍、胆囊管残留过长、残余小胆囊及非胆道疾病等。ERCP是明确PCS病因较为理想和可靠的方法 ,如结合B超、胃镜检查以及上消化道钡餐 。Objective The etiology and diagnostic measures of postcholecystectomy syndrome (PCS) were explored and the function of endoscopic retrograde cholangiopancretography (ERCP) was evaluated in etiological diagnosis of PCS by analysis of clinical data of 124 patients with PCS. Methods B-type ultrasound, endoscopy or barium meal of upper digestive tract and ERCP were performed in 124 patients with PCS to identify the etiology of PCS. Results ERCP was succeeded in 114 cases (93 5%). Biliary stone was found in 68 cases, dilatation and stricture of bile in 47 and 26 cases, respectively, more remnant of cholecyst duct and residual mini gallbladder in 11 cases, duodenal papilla with outlet located in the inner or marginal of duodenal diverticulum in 11cases, no abnormal endoscopic findings in 23 cases and the other etiology which is not ascribed to biliary tract diseases in 15 cases. Conclusions The biliary stone and stricture of bile are the most common etiology in PCS. The other causes include duodenal diverticulum, dysfunction of Oddi sphincter, more remnant of cholecyst duct and residual mini gallbladder and non-biliary tract diseases. ERCP is ideal and reliable in the identification of etiological diagnosis in PCS. More accurate etiological diagnosis of PCS will be made by ERCP combined with B-type ultrasound, endoscopy or barium meal of upper digestive tract.

关 键 词：逆行胰胆管造影 病因学 胆囊切除术 

分 类 号：R657.4[医药卫生—外科学]