十二指肠镜在诊治腹腔镜胆道术后并发症中的应用价值

目的探讨十二指肠镜在诊断及治疗腹腔镜胆道术后并发症的应用价值。方法自2002年1月至2008年6月，应用十二指肠镜诊治腹腔镜胆道术后并发症患者123例，根据具体类型进行针对性治疗，并对十：二指肠镜治疗效果进行回顾性分析。结果123例胆道并发症者中，胆道残余结石58例，56例结石排出；胆汁漏40例，38例治愈，避免开腹手术；胆总管下端狭窄11例，全部治愈；三管汇合处狭窄8例行胆道支架治疗，5例远期效果满意；肝门部胆管狭窄2例，胆管完全横断4例，经ERCP明确诊断后均行外科手术。：本组十二指肠镜治疗总的并发症发生率为4．88％，无严重并发症。结论针对腹腔镜胆道术后并发症，十二指肠镜是一种微创、安全、有效的诊断和治疗方法，对于胆管残余结石、胆汁漏、胆管下端狭窄疗效确切；对于胆管部分狭窄，十二指肠镜下胆道内支架作为一种可选择的治疗手段，使多数患者免受开腹手术之苦。

Application of duodenoscopy in the diagnosis and treatment of complications after laparoscopic biliary operation

Objective To explore the value of duodenoscopy in the diagnosis and treatment of complications after laparoscopic biliary operation. Methods From January 2002 to June 2008, totally 123 patients with laparoscopic biliary postoperative complications were referred for ERCP and received suitable therapies according to the special conditions of complications. The success rate and postoperative results were observed and analyzed. Results All cases were correctly diagnosed by ERCP. Fifty-eight patients had residual stones in the common bile duct, 56 cases were successfully treated with endoscopic papillotomy and stone extraction. Of 40 cases with a biliary leak, 38 patients were cured aviding of surgical operation. Eleven patients with a stenosis at the inferior of common bile duct were fully recovered. Eight patients with a partial biliary stricture were treated by endoscopic stenting as a primary procedure. Five cases had satisfactory outcome after long term follow-up. After diagnostic ERCP were per- formed for 2 patients with hepatic portal bile duct stricture and 4 patients with complete transection lesion of biliary duct, they underwent surgical operation. The early complications of endoscopic diagnosis and therapy occurred in six patients（4.88%）. There were no serious postoperative complications. Conclusions ERCP is recommended as a safe and efficacious intervention to detect and treat laparoscopic biliary postoperative complications. Duodenoscopy is effective for the treatment of residual stones, bile leakage and stenosis at the end of common bile duct. Endoscopic stenting may be a selective modality for those with partial biliary stricture and avoid unnecessary laparotomy.