胆囊切除术后综合征116例ERCP分析

目的探讨胆囊切除术后综合征的病因。方法回顾性总结分析2000年1月至2004年12月间临床诊断为胆囊切除术后综合征的116例ERCP资料。结果本组116例胆管显影率100％，胰管显影97例（83．62％）。原因为胆总管结石56例（48．28％），十二指肠憩室、憩室内乳头19例（16．34％），胆囊管残留过长、胆囊管结石15例（12．93％），胆总管末端良性狭窄13例（11．20），Oddis括约肌运动功能障碍4例（3．45％），十二指肠乳头肿瘤3例（2．59％），胆管损伤狭窄2例（1．73％），硬化性胆管炎1例（0．86％），胆管癌1例（0．86％），残留胆囊伴结石1例（0．86％），慢性胰腺炎伴胰管结石1例（0．86％）。结论胆囊切除术后综合征的原因以胆总管结石、十二指肠憩室、憩室内乳头、胆囊管残留过长、胆囊管结石、胆总管末端良性狭窄、Oddis括约肌运动功能障碍多见。胆囊切除术后术前症状不缓解或术后又复出现症状，不能拘于胆囊切除术后综合征的诊断，而是应积极寻找病因，以求得到合理治疗。

Analysis of postcholecystectomy syndrome by ERCP in 116 cases

Objective To investigate the pathogeny of postcholecystectomy syndrome (PCS). Methods The ERCP data of 116 patients with PCS treated in our hospital from January 2000 to December 2004 were retrospectively analyzed. Results The bile duct was imaged in all the 116 patients and pancreatic duct was done in 97 of them. The PCS was caused by choledocolithiasis in 56 patients (48. 28%), diverticulum of duodenum or papillary in diverticulum in 19 (16. 34%), too long residual cystic duct or stones in it in 15 (12. 93%), the end stenosis of terminal common bile duct in 13 (11. 20%), Oddi's sphincter dysfunction in 4 (3. 45%), tumor of duodenal papillary in 3 (2. 59%), stenosis of injured bile duct in 2 (1. 73%), sclerosing cholangitis in 1 (0. 86%), cholangiocarcinoma in 1 (0.86%), remained gallbladder with stones in 1 (0.86%), chronic pancreatitis with pancreatic ductal lithiasis in 1 (0. 86%). Conclusions The common pathogenies of PCS are choledocholithiasis, diverticulum of duodenum, papillary in diverticulum, too long residual cystic duct, stones in cystic duct, benign stenpsis of terminal common bile duct and Oddi's sphincter dysfunction. If the symptoms do not relieve or appear again after cholecystectomy, we should not limit on the diagnosis of PCS. We should be keen on finding the pathogeny to give rational treatment.